MEDICARE: MARSHALL M TRABOUT 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	147937	NY

General Provider Information

NPI Number	:	1558340331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARSHALL M TRABOUT MD

Provider Business Mailing Address
First Line	:	1001 W FAYETTE ST
Second Line	:	STE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2859
Country	:	US
Telephone Number	:	315-472-1488
Fax Number	:	315-472-8060

Provider Business Practice Location Address
First Line	:	18 WELLS RD
Second Line	:
City	:	AURORA
State	:	NY
Zip	:	13026
Country	:	US
Telephone Number	:	315-364-3388
Fax Number	:	315-364-5254

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	05/12/2008

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