Provider Demographics
NPI:1386678233
Name:SEYMOUR, MARY L (NP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:L
Other - Last Name:FENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 SENECA ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 SENECA ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2653
Practice Address - Country:US
Practice Address - Phone:315-464-1998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY300426363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02552867Medicaid
NY02552867Medicaid
P23616Medicare UPIN