MEDICARE: BARBARA V GANNON 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
1	174400000X	Specialist	236442	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	:	1992770382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA V GANNON M.D.

Provider Business Mailing Address
First Line	:	206 CORNELIA ST
Second Line	:	SUITE 306
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2779
Country	:	US
Telephone Number	:	518-566-9452
Fax Number	:	518-562-7189

Provider Business Practice Location Address
First Line	:	206 CORNELIA ST
Second Line	:	SUITE 306
City	:	PLATTSBURGH
State	:	NY
Zip	:	12901-2779
Country	:	US
Telephone Number	:	518-566-9452
Fax Number	:	518-562-7189

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

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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