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General NPI Number Information
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NPI Number | 1790979417
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Entity Type | Organization
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Legal Business Name | ITHACA DERMATOLOGY PLLC
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Dates
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Enumeration Date | 09/06/2007
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Last Update Date | 01/27/2010
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Provider Practice Location Address
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Address Line | 821 CLIFF STREET
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City | ITHACA
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State | NY
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Zip | 14850
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Country | US
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Telephone | 607-256-7546
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Fax | 607-256-0049
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Provider Business Mailing Address
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Address Line | 202 TAUGHANNOCK BLVD PO BOX 366
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City | ITHACA
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State | NY
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Zip | 14851
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Country | US
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Telephone | 607-277-4035
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Fax | 607-277-3888
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY SILVERS
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Credential |
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Telephone | 607-256-7546
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 220803
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License Number State | NY
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