Provider Demographics
NPI:1679609317
Name:MCALLISTER, JOSEPHINE C (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:C
Last Name:MCALLISTER
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 1:1051 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:076-257-0369
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
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY250861207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03131940Medicaid
NY03131940Medicaid
NYJ400005434Medicare PIN