MEDICARE: KERRY A PURTILL 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	208000000X	Pediatrics Physician	224666	NY

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	:	1639170905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY A PURTILL MD

Provider Business Mailing Address
First Line	:	1 ELM ST
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3925
Country	:	US
Telephone Number	:	914-337-7474
Fax Number	:	914-961-0058

Provider Business Practice Location Address
First Line	:	1 ELM ST
Second Line	:
City	:	TUCKAHOE
State	:	NY
Zip	:	10707-3925
Country	:	US
Telephone Number	:	914-337-7474
Fax Number	:	914-961-0058

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

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	07/24/2008

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