MEDICARE: PATSY M IANNOLO MD, PHD, P C

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1366582694
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATSY M IANNOLO MD, PHD, P C

Provider Business Mailing Address
First Line	:	5180 W TAFT RD
Second Line	:	P O BOX 346
City	:	N SYRACUSE
State	:	NY
Zip	:	13212-2601
Country	:	US
Telephone Number	:	315-458-4622
Fax Number	:	315-458-9629

Provider Business Practice Location Address
First Line	:	5180 W TAFT RD
Second Line	:
City	:	N SYRACUSE
State	:	NY
Zip	:	13212-2601
Country	:	US
Telephone Number	:	315-458-4622
Fax Number	:	315-458-9629

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PATSY M IANNOLO
Credential	:	M.D.
Telephone Number	:	315-452-4622

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	12/13/2012

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