Healthcare Provider Details

I. General information

NPI: 1801872924
Provider Name (Legal Business Name): ROBERT TODD MORASON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 UNIVERSITY AVE
SYRACUSE NY
13210
US

IV. Provider business mailing address

612 UNIVERSITY AVE
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-422-2020
  • Fax: 315-422-7339
Mailing address:
  • Phone: 315-422-2020
  • Fax: 315-422-7339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number216992
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: