Healthcare Provider Details

I. General information

NPI: 1295779445
Provider Name (Legal Business Name): CATHERINE T OHARA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 IRVING AVE
SYRACUSE NY
13210-2716
US

IV. Provider business mailing address

69 N BEAVER ST
JORDAN NY
13080-9528
US

V. Phone/Fax

Practice location:
  • Phone: 315-425-4638
  • Fax:
Mailing address:
  • Phone: 315-689-6787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF300030-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: