Healthcare Provider Details

I. General information

NPI: 1528056637
Provider Name (Legal Business Name): TERRY LEE PUMMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL DR
MASSENA NY
13662-1056
US

IV. Provider business mailing address

50 LEROY ST
POTSDAM NY
13676-1786
US

V. Phone/Fax

Practice location:
  • Phone: 315-769-4392
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS012759
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21836
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number337465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: