Provider Demographics
NPI:1538321658
Name:DARGIE MEDICAL PLLC
Entity Type:Organization
Organization Name:DARGIE MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DARGIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-379-1024
Mailing Address - Street 1:39 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617-1271
Mailing Address - Country:US
Mailing Address - Phone:315-379-1024
Mailing Address - Fax:315-379-9358
Practice Address - Street 1:39 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617-1271
Practice Address - Country:US
Practice Address - Phone:315-379-1024
Practice Address - Fax:315-379-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200449-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01608204Medicaid
NY01608204Medicaid