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General NPI Number Information
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NPI Number | 1831122399
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Entity Type | Individual
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Provider Name | MICHELE A PAVILLARD D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 10/21/2019
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Provider Practice Location Address
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Address Line | 290 E 1ST ST SUITE 1
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City | CORNING
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State | NY
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Zip | 14830-2925
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Country | US
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Telephone | 607-936-1244
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Fax | 607-936-4023
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Provider Business Mailing Address
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Address Line | 290 E 1ST ST
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City | CORNING
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State | NY
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Zip | 14830-2925
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Country | US
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Telephone | 607-936-1244
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Fax | 607-734-6293
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 186609
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License Number State | NY
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