MEDICARE: JOHN P. GAVIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207YP0228X	Pediatric Otolaryngology Physician	244142	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	244142	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1023211745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN P. GAVIN M.D.

Provider Business Mailing Address
First Line	:	50 NEW SCOTLAND AVE FL 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3403
Country	:	US
Telephone Number	:	518-262-6240
Fax Number	:	518-262-4223

Provider Business Practice Location Address
First Line	:	50 NEW SCOTLAND AVE FL 2
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12208-3403
Country	:	US
Telephone Number	:	518-262-6240
Fax Number	:	518-262-4223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2007
Last Update Date	:	05/23/2022

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