Provider Demographics
NPI:1518165125
Name:CORTLAND MEDICAL CARE, PC
Entity Type:Organization
Organization Name:CORTLAND MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAGADISH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAKAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-753-3355
Mailing Address - Street 1:929 LIMERICK LN
Mailing Address - Street 2:
Mailing Address - City:HOMER
Mailing Address - State:NY
Mailing Address - Zip Code:13077-9300
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:129 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1230
Practice Address - Country:US
Practice Address - Phone:607-753-3355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-05
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY247103-1OtherLICENSE#
NY247103-1OtherLICENSE#