Provider Demographics
NPI:1871650697
Name:WITHIAM, ALAN G (MD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:G
Last Name:WITHIAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4314 SWAMP COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:TRUMANSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14886-9165
Mailing Address - Country:US
Mailing Address - Phone:607-387-3655
Mailing Address - Fax:
Practice Address - Street 1:1083 WATERLOO GENEVA RD
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:NY
Practice Address - Zip Code:13165-1202
Practice Address - Country:US
Practice Address - Phone:607-869-5609
Practice Address - Fax:607-869-5303
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY155579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine