MEDICARE: OGDENSBURG MEDICAL GROUP P.C.

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	207R00000X	Internal Medicine Physician	108852	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	:	1871590745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OGDENSBURG MEDICAL GROUP P.C.

Provider Business Mailing Address
First Line	:	PO BOX 308
Second Line	:	1231 CONGRESS ST
City	:	OGDENSBURG
State	:	NY
Zip	:	13669
Country	:	US
Telephone Number	:	315-393-2295
Fax Number	:	315-393-9604

Provider Business Practice Location Address
First Line	:	1231 CONGRESS ST
Second Line	:
City	:	OGDENSBURG
State	:	NY
Zip	:	13669-3268
Country	:	US
Telephone Number	:	315-393-2295
Fax Number	:	315-393-9604

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FREDERICO A LOINAZ
Credential	:	M.D.
Telephone Number	:	315-393-2295

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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