Healthcare Provider Details

I. General information

NPI: 1740443548
Provider Name (Legal Business Name): DEPARTMENT OF MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2008
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 HARRISON ST SUITE 200
SYRACUSE NY
13202-3188
US

IV. Provider business mailing address

550 HARRISON ST SUITE 200
SYRACUSE NY
13202-3188
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-6527
  • Fax: 315-464-6529
Mailing address:
  • Phone: 315-464-6527
  • Fax: 315-464-6529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number251934
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: SARAH LYNNE LAPPIN
Title or Position: DO
Credential: DO
Phone: 315-464-6527