Provider Demographics
NPI:1326184490
Name:FAMILY MEDICINE ASSOCIATES OF ITHACA LLP
Entity Type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF ITHACA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:A
Authorized Official - Last Name:DARLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-257-5263
Mailing Address - Street 1:209 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-5429
Mailing Address - Country:US
Mailing Address - Phone:607-257-5263
Mailing Address - Fax:
Practice Address - Street 1:209 W STATE ST
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-5429
Practice Address - Country:US
Practice Address - Phone:607-257-5263
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY37084AMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER