Healthcare Provider Details

I. General information

NPI: 1720653611
Provider Name (Legal Business Name): MEGAN ANN GILBERT AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 01/02/2025
Certification Date: 06/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

IV. Provider business mailing address

750 EAST ADAMS ST
SYRACUSE NY
13210-2306
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-8200
  • Fax: 315-464-8206
Mailing address:
  • Phone: 315-464-8200
  • Fax: 315-464-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number310014
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number310014
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: