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NPI Code Detail

MEDICARE: ANDRES M MADISSOO M.D.

MEDICARE: ANDRES M MADISSOO M.D.
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
1208800000XUrology Physician203934NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770570517
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDRES M MADISSOO M.D.
Provider Business Mailing Address
First Line : 1226 E WATER ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1155
Country : US
Telephone Number : 315-478-4185
Fax Number : 315-478-0840
Provider Business Practice Location Address
First Line : 1226 E WATER ST
Second Line :
City : SYRACUSE
State : NY
Zip : 13210-1155
Country : US
Telephone Number : 315-478-4185
Fax Number : 315-478-0840
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/05/2005
Last Update Date : 06/21/2012

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Directions to “ ANDRES M MADISSOO M.D.” Practice Location

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