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General NPI Number Information
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NPI Number | 1417994716
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Entity Type | Individual
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Provider Name | JARED MICHAEL WIDELL MD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2006
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | GUTHRIE CORTLAND MEDICAL CENTER 134 HOMER AVENUE
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City | CORTLAND
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State | NY
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Zip | 13045
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Country | US
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Telephone | 607-756-3561
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Fax | 607-756-3562
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Provider Business Mailing Address
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Address Line | 1 GUTHRIE SQ
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City | SAYRE
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State | PA
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Zip | 18840-1625
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Country | US
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Telephone | 570-888-5858
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 176591
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | MD034608
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License Number State | DC
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