Healthcare Provider Details

I. General information

NPI: 1851510697
Provider Name (Legal Business Name): UMESCHANDRA B PATIL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 11/08/2007
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: 315-464-8246
  • Fax: 315-464-6117
Mailing address:
  • Phone: 315-464-8246
  • Fax: 315-464-6117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number110121
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: