Provider Demographics
NPI:1669454492
Name:WESTPFAL, EDITH M (MD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:M
Last Name:WESTPFAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 BROAD RD., PHYSICIANS OFFICE BUILDING SOUTH
Mailing Address - Street 2:SUITE 2H
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13215-2265
Mailing Address - Country:US
Mailing Address - Phone:315-492-2520
Mailing Address - Fax:315-492-2986
Practice Address - Street 1:4900 BROAD RD., PHYSICIANS OFFICE BUILDING SOUTH
Practice Address - Street 2:SUITE 2H
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:315-492-2520
Practice Address - Fax:315-492-2986
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2153621207V00000X
NY215362207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02048960Medicaid
NY02048960Medicaid
NYH13716Medicare UPIN