Provider Demographics
NPI:1497832059
Name:LAND, RAMONA MAE
Entity Type:Individual
Prefix:MS
First Name:RAMONA
Middle Name:MAE
Last Name:LAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1882
Mailing Address - Country:US
Mailing Address - Phone:607-723-5130
Mailing Address - Fax:607-723-4087
Practice Address - Street 1:168 WATER ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901-2755
Practice Address - Country:US
Practice Address - Phone:607-723-5130
Practice Address - Fax:607-723-4087
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001732-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1885Medicare ID - Type Unspecified
R84424Medicare UPIN