Provider Demographics
NPI:1427028117
Name:MCGINNIS, KERMIT D (MD)
Entity Type:Individual
Prefix:DR
First Name:KERMIT
Middle Name:D
Last Name:MCGINNIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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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:14850-3328
Mailing Address - Country:US
Mailing Address - Phone:607-277-4035
Mailing Address - Fax:607-277-3888
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1651
Practice Address - Country:US
Practice Address - Phone:315-787-4533
Practice Address - Fax:315-787-4469
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY235789207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02660295Medicaid
NYRA7119Medicare ID - Type Unspecified
NYI32193Medicare UPIN