Healthcare Provider Details

I. General information

NPI: 1306272158
Provider Name (Legal Business Name): IVANCARMINE GAMBARDELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

739 IRVING AVE STE 640
SYRACUSE NY
13210
US

IV. Provider business mailing address

739 IRVING AVE STE 640
SYRACUSE NY
13210
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-6255
  • Fax: 315-364-6251
Mailing address:
  • Phone: 315-464-6255
  • Fax: 315-364-6251

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number293597
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: