Provider Demographics
NPI:1659506111
Name:FRANCIS, DESMOND (MD)
Entity Type:Individual
Prefix:
First Name:DESMOND
Middle Name:
Last Name:FRANCIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 BLACK RIVER BLVD N
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-2427
Mailing Address - Country:US
Mailing Address - Phone:315-337-3770
Mailing Address - Fax:315-337-5380
Practice Address - Street 1:1801 BLACK RIVER BLVD N
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-2427
Practice Address - Country:US
Practice Address - Phone:315-337-3770
Practice Address - Fax:315-337-5380
Is Sole Proprietor?:No
Enumeration Date:2009-05-27
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269221207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03625321Medicaid