MEDICARE: DR. HEATHER NICOLE UNDERHILL D.O.

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	207Q00000X	Family Medicine Physician	284889	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1740628791
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER NICOLE UNDERHILL D.O.

Provider Business Mailing Address
First Line	:	1138 BROADWAY ST
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14904-2502
Country	:	US
Telephone Number	:	607-734-7982
Fax Number	:

Provider Business Practice Location Address
First Line	:	571 SAINT JOSEPHS BLVD FL 2
Second Line	:
City	:	ELMIRA
State	:	NY
Zip	:	14901-3230
Country	:	US
Telephone Number	:	607-271-2050
Fax Number	:

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	09/15/2016

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