Healthcare Provider Details

I. General information

NPI: 1487686457
Provider Name (Legal Business Name): KEVIN G RAGOSTA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 05/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 E ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-5450
  • Fax: 315-464-6322
Mailing address:
  • Phone: 315-464-5450
  • Fax: 315-464-6322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number184754
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: