Healthcare Provider Details

I. General information

NPI: 1790240976
Provider Name (Legal Business Name): KIRSTEN P MAGOWAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2019
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7278 BUCKLEY RD
NORTH SYRACUSE NY
13212-2649
US

IV. Provider business mailing address

7278 BUCKLEY RD
NORTH SYRACUSE NY
13212-2649
US

V. Phone/Fax

Practice location:
  • Phone: 315-452-1471
  • Fax:
Mailing address:
  • Phone: 315-452-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT DANIEL MAGOWAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 315-452-1471