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NPI Code Detail

MEDICARE: SEAN E SECORD P.A.

MEDICARE: SEAN E SECORD P.A.
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
1363A00000XPhysician Assistant009229NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295780633
Entity Type Code : Individual
Provider Name (Legal Business Name) : SEAN E SECORD P.A.
Provider Business Mailing Address
First Line : PO BOX 725
Second Line :
City : COOPERSTOWN
State : NY
Zip : 13326-0725
Country : US
Telephone Number : 607-746-0550
Fax Number : 607-746-0568
Provider Business Practice Location Address
First Line : 460 ANDES RD
Second Line :
City : DELHI
State : NY
Zip : 13753-7407
Country : US
Telephone Number : 607-746-0550
Fax Number : 607-746-0568
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 02/05/2009

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Directions to “ SEAN E SECORD P.A.” Practice Location

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