Provider Demographics
NPI:1669477170
Name:TINSLEY, ROGER W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:W
Last Name:TINSLEY
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 1:17 E GENESEE ST
Mailing Address - Street 2:STE 101
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-4040
Mailing Address - Country:US
Mailing Address - Phone:315-255-3331
Mailing Address - Fax:315-255-6145
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:STE 101
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4040
Practice Address - Country:US
Practice Address - Phone:315-255-3331
Practice Address - Fax:315-255-6145
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127128207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00573313Medicaid
NY127128OtherNYS LICENSE
NY161568469OtherEIN
NY1164140001Medicare NSC
NY127128OtherNYS LICENSE
NYB81646Medicare UPIN