Healthcare Provider Details

I. General information

NPI: 1942528997
Provider Name (Legal Business Name): MATTHEW CROSBY O'CONNOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2010
Last Update Date: 07/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 PROSPECT AVE PEDIATRIX MEDICAL GROUP
SYRACUSE NY
13203-1807
US

IV. Provider business mailing address

301 PROSPECT AVE PEDIATRIX MEDICAL GROUP
SYRACUSE NY
13203-1807
US

V. Phone/Fax

Practice location:
  • Phone: 315-448-5287
  • Fax: 315-448-6167
Mailing address:
  • Phone: 315-448-5287
  • Fax: 315-448-6167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number284031-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: