Provider Demographics
NPI:1134130487
Name:MICHELE A PAVILLARD D.O.
Entity Type:Organization
Organization Name:MICHELE A PAVILLARD D.O.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O.
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAVILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:607-936-1244
Mailing Address - Street 1:111 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ELMIRA HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:14903-1303
Mailing Address - Country:US
Mailing Address - Phone:607-734-9539
Mailing Address - Fax:607-734-6293
Practice Address - Street 1:290 E 1ST ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2925
Practice Address - Country:US
Practice Address - Phone:607-936-1244
Practice Address - Fax:607-936-4023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
BA0544Medicare ID - Type Unspecified