Provider Demographics
NPI:1558342477
Name:ADVANTAGEHEALTH MEDICAL SERVICES, PC
Entity Type:Organization
Organization Name:ADVANTAGEHEALTH MEDICAL SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANGORDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-737-1509
Mailing Address - Street 1:571 E MARKET ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-733-4659
Mailing Address - Fax:607-733-4650
Practice Address - Street 1:571 E MARKET ST
Practice Address - Street 2:SUITE 307
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14901-3230
Practice Address - Country:US
Practice Address - Phone:607-733-4659
Practice Address - Fax:607-733-4650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Not Answered207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0678Medicare PIN