Provider Demographics
NPI:1609170992
Name:JOSEPHINE C. MCALLISTER, M.D., LLC
Entity Type:Organization
Organization Name:JOSEPHINE C. MCALLISTER, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRAZAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:607-257-1107
Mailing Address - Street 1:1051 CRAFT RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1016
Mailing Address - Country:US
Mailing Address - Phone:607-257-1107
Mailing Address - Fax:607-257-0369
Practice Address - Street 1:1051 CRAFT RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1016
Practice Address - Country:US
Practice Address - Phone:607-257-1107
Practice Address - Fax:607-257-0369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250861207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400005298Medicare PIN