Provider Demographics
NPI:1083670301
Name:AUBURN RADIOLOGIC ASSOCIATES
Entity Type:Organization
Organization Name:AUBURN RADIOLOGIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CANNUCCIARRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-255-2828
Mailing Address - Street 1:281 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1421
Mailing Address - Country:US
Mailing Address - Phone:315-255-2828
Mailing Address - Fax:
Practice Address - Street 1:144 GENESEE ST
Practice Address - Street 2:METCALF PLAZA, SUITE 304
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-3503
Practice Address - Country:US
Practice Address - Phone:315-258-8415
Practice Address - Fax:315-255-1129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1384292085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty