Healthcare Provider Details

I. General information

NPI: 1770571101
Provider Name (Legal Business Name): SUZANNE KOCHWESER ANDERSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

172 KING RD E
ITHACA NY
14850-9403
US

IV. Provider business mailing address

4435 SENECA RD
TRUMANSBURG NY
14886-9201
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-0212
  • Fax: 607-277-3785
Mailing address:
  • Phone: 607-387-5707
  • Fax: 607-387-4354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number155383
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number155383
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: