Provider Demographics
NPI:1124038443
Name:WILCOX, GUY H (MD)
Entity Type:Individual
Prefix:
First Name:GUY
Middle Name:H
Last Name:WILCOX
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 BLEECKER ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1738
Mailing Address - Country:US
Mailing Address - Phone:315-798-4846
Mailing Address - Fax:315-798-4740
Practice Address - Street 1:2150 BLEECKER ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-1738
Practice Address - Country:US
Practice Address - Phone:315-798-4846
Practice Address - Fax:315-798-4740
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131403-1207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB82906Medicare UPIN
NYBB4976Medicare ID - Type UnspecifiedMEDICARE# - GROUP 810470A