Provider Demographics
NPI:1689693004
Name:AVANZATO, JOHN (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:AVANZATO
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:AMMS, PC
Mailing Address - Street 2:17 LANSING STREET
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-567-0455
Mailing Address - Fax:315-255-7099
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:13021-4112
Practice Address - Country:US
Practice Address - Phone:315-567-0490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176705207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01256028Medicaid
NYDD6101Medicare ID - Type Unspecified
NY01256028Medicaid