=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255473336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT A HESSON, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2007
-----------------------------------------------------
Last Update Date | 01/27/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 DATES DRIVE SUITE 206
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-273-9111
-----------------------------------------------------
Fax | 607-273-5580
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 202 TAUGHANNOCK BLVD. PO BOX 366
-----------------------------------------------------
City | ITHACA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 607-277-3257
-----------------------------------------------------
Fax | 607-277-4056
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. ROBERT HESSON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 607-273-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RN0300X
-----------------------------------------------------
Taxonomy Name | Nephrology Physician
-----------------------------------------------------
License Number | 159615
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------