Provider Demographics
NPI:1992858138
Name:BARBARA A CONNOR MD & CHESTER L PATRICK JR MD PC
Entity Type:Organization
Organization Name:BARBARA A CONNOR MD & CHESTER L PATRICK JR MD PC
Other - Org Name:CONNOR AND PATRICK JR
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHESTER
Authorized Official - Middle Name:L
Authorized Official - Last Name:PATRICK
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-336-0250
Mailing Address - Street 1:215 W THOMAS ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-5018
Mailing Address - Country:US
Mailing Address - Phone:315-336-0250
Mailing Address - Fax:315-336-0919
Practice Address - Street 1:215 W THOMAS ST
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:NY
Practice Address - Zip Code:13440-5018
Practice Address - Country:US
Practice Address - Phone:315-336-0250
Practice Address - Fax:315-336-0919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY155428207R00000X
NYNY155407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00780290Medicaid
NY00780236Medicaid
NY00780290Medicaid
NY50099AMedicare PIN