Provider Demographics
NPI:1255473336
Name:ROBERT A HESSON, MD
Entity Type:Organization
Organization Name:ROBERT A HESSON, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-273-9111
Mailing Address - Street 1:202 TAUGHANNOCK BLVD.
Mailing Address - Street 2:PO BOX 366
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-277-3257
Mailing Address - Fax:607-277-4056
Practice Address - Street 1:201 DATES DRIVE
Practice Address - Street 2:SUITE 206
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-273-9111
Practice Address - Fax:607-273-5580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159615207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01959397Medicaid
NY01959397Medicaid