Healthcare Provider Details

I. General information

NPI: 1013910256
Provider Name (Legal Business Name): JOSE MARIA ACOSTAMADIEDO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 10/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 CORNELIA ST
PLATTSBURGH NY
12901-2306
US

IV. Provider business mailing address

212 CORNELIA ST
PLATTSBURGH NY
12901-2306
US

V. Phone/Fax

Practice location:
  • Phone: 518-562-7100
  • Fax:
Mailing address:
  • Phone: 518-562-7100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number291399
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: