Provider Demographics
NPI:1790886315
Name:ROGER W TINSLEY MD PC
Entity Type:Organization
Organization Name:ROGER W TINSLEY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:W
Authorized Official - Last Name:TINSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-255-3331
Mailing Address - Street 1:17 E GENESEE ST
Mailing Address - Street 2:SUITE 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:
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:SUITE 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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127128207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00573313Medicaid
NY1669477170OtherINDIVIDUAL NPI
BB1646Medicare UPIN
NYBB6137Medicare ID - Type UnspecifiedINDIVIDUAL MEDICARE
NYAAO317Medicare ID - Type UnspecifiedGROUP MEDICARE #