Healthcare Provider Details

I. General information

NPI: 1255491387
Provider Name (Legal Business Name): ARCADIA FAMILY PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3669 COUNTRYSIDE LN
MARION NY
14505-9781
US

IV. Provider business mailing address

PO BOX 110
MARION NY
14505-0110
US

V. Phone/Fax

Practice location:
  • Phone: 315-926-7733
  • Fax:
Mailing address:
  • Phone: 315-926-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number156845
License Number StateNY

VIII. Authorized Official

Name: DAVID HANNAN
Title or Position: PRESIDENT
Credential:
Phone: 315-926-7733