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General NPI Number Information
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NPI Number | 1861473597
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Entity Type | Individual
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Provider Name | MARINA WASYLYSHYN M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 02/28/2018
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Provider Practice Location Address
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Address Line | 49 COURT ST STE 2
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City | BINGHAMTON
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State | NY
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Zip | 13901-3236
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Country | US
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Telephone | 607-770-4071
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 718
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City | JOHNSON CITY
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State | NY
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Zip | 13790-0718
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Country | US
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Telephone | 607-770-4071
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | NY193327
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | NY193327
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License Number State | NY
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