MEDICARE: DENISE OCTAVIANI 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	207QA0000X	Adolescent Medicine (Family Medicine) Physician	197696-1	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	:	1841286325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENISE OCTAVIANI D.O.

Provider Business Mailing Address
First Line	:	7999 AUSTRIAN PINE CIR
Second Line	:
City	:	MANLIUS
State	:	NY
Zip	:	13104-9372
Country	:	US
Telephone Number	:	315-703-3263
Fax Number	:	315-425-1994

Provider Business Practice Location Address
First Line	:	1223 N SALINA ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13208-1519
Country	:	US
Telephone Number	:	315-703-3263
Fax Number	:	315-425-1994

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	03/05/2008

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Directions to “ DENISE OCTAVIANI D.O.” Practice Location

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