Provider Demographics
NPI:1497711980
Name:CORTLAND INTERNIST ASSOCIATES
Entity Type:Organization
Organization Name:CORTLAND INTERNIST ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:GAUSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-756-4974
Mailing Address - Street 1:6 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1257
Mailing Address - Country:US
Mailing Address - Phone:607-756-4974
Mailing Address - Fax:
Practice Address - Street 1:6 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1257
Practice Address - Country:US
Practice Address - Phone:607-756-4974
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01636180Medicaid
NY01636180Medicaid