Healthcare Provider Details

I. General information

NPI: 1942237359
Provider Name (Legal Business Name): MICHAEL ANDREW LACOMBE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 EAST GENESEE ST SUITE 101
SYRACUSE NY
13210
US

IV. Provider business mailing address

1000 EAST GENESEE ST SUITE 101
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-476-3535
  • Fax: 315-476-4140
Mailing address:
  • Phone: 315-476-3535
  • Fax: 315-476-4140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number036-088056
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number263368
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: