MEDICARE: JASON M MEROLA MD

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	224123	NY

General Provider Information

NPI Number	:	1467480897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON M MEROLA MD

Provider Business Mailing Address
First Line	:	750 E ADAMS ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-2306
Country	:	US
Telephone Number	:	315-464-6527
Fax Number	:

Provider Business Practice Location Address
First Line	:	550 HARRISON ST
Second Line	:	SUITE 200
City	:	SYRACUSE
State	:	NY
Zip	:	13202-3096
Country	:	US
Telephone Number	:	315-464-6527
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	10/01/2007

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