MEDICARE: JOHN OPPENHEIMER, M.D., PLLC

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	150853	NY

General Provider Information

NPI Number	:	1780956441
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN OPPENHEIMER, M.D., PLLC

Provider Business Mailing Address
First Line	:	PO BOX 3137
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-0405
Country	:	US
Telephone Number	:	621-725-4600
Fax Number	:

Provider Business Practice Location Address
First Line	:	60 BAY ST
Second Line	:
City	:	SAG HARBOR
State	:	NY
Zip	:	11963-3106
Country	:	US
Telephone Number	:	621-725-4600
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAN
Name	:	DR. JOHN OPPENHEIMER
Credential	:	M.D.
Telephone Number	:	631-725-4600

Provider Enumeration Date	:	01/27/2012
Last Update Date	:	01/27/2012

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