Provider Demographics
NPI:1831140276
Name:PFAU, KRISTEN GUEST (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:GUEST
Last Name:PFAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:ELIZABETH
Other - Last Name:GUEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:3922 FENNELL ST
Practice Address - Street 2:
Practice Address - City:SKANEATELES
Practice Address - State:NY
Practice Address - Zip Code:13152-9316
Practice Address - Country:US
Practice Address - Phone:315-685-0908
Practice Address - Fax:315-685-1922
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238528207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB0857Medicare PIN
NYP00358415Medicare PIN