MEDICARE: GIANNA OF SYRACUSE MEDICAL PLLC

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	207Q00000X	Family Medicine Physician

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

General Provider Information

NPI Number	:	1104451848
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GIANNA OF SYRACUSE MEDICAL PLLC

Provider Business Mailing Address
First Line	:	1141 EAST UNION ST.
Second Line	:	#9201
City	:	SYRACUSE
State	:	NY
Zip	:	13219-1919
Country	:	US
Telephone Number	:	585-310-8787
Fax Number	:

Provider Business Practice Location Address
First Line	:	1880 E RIDGE RD STE 8
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14622-2450
Country	:	US
Telephone Number	:	585-310-8787
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ANGELA KRISTAN
Credential	:	MD
Telephone Number	:	405-640-5576

Provider Enumeration Date	:	03/03/2020
Last Update Date	:	02/28/2025

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