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General NPI Number Information
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NPI Number | 1790240976
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Entity Type | Organization
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Legal Business Name | KIRSTEN P MAGOWAN MD PC
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Dates
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Enumeration Date | 02/01/2019
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Last Update Date | 02/01/2019
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Provider Practice Location Address
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Address Line | 7278 BUCKLEY RD
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-2649
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Country | US
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Telephone | 315-452-1471
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Fax |
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Provider Business Mailing Address
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Address Line | 7278 BUCKLEY RD
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City | NORTH SYRACUSE
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State | NY
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Zip | 13212-2649
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Country | US
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Telephone | 315-452-1471
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | ROBERT DANIEL MAGOWAN
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Credential |
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Telephone | 315-452-1471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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