Provider Demographics
NPI:1972913887
Name:LANDIN, JESSICA M (MD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:LANDIN
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 1:6102 HAMPSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-2517
Mailing Address - Country:US
Mailing Address - Phone:914-309-4888
Mailing Address - Fax:
Practice Address - Street 1:475 IRVING AVE STE 108
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-671-0070
Practice Address - Fax:315-475-0620
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-30
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY294188207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program