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General NPI Number Information
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NPI Number | 1124247192
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Entity Type | Individual
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Provider Name | ANITA G AMIDON M.D.
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Gender | Female
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Dates
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Enumeration Date | 04/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 600 FRENCH RD
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City | NEW HARTFORD
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State | NY
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Zip | 13413-1037
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Country | US
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Telephone | 315-738-1662
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Fax |
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Provider Business Mailing Address
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Address Line | 111 JUBILEE LN
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City | NEW HARTFORD
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State | NY
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Zip | 13413-4401
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | 204344-1
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License Number State | NY
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