Provider Demographics
NPI:1013910256
Name:ACOSTAMADIEDO, JOSE MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MARIA
Last Name:ACOSTAMADIEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 CORNELIA ST
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2306
Mailing Address - Country:US
Mailing Address - Phone:518-562-7100
Mailing Address - Fax:
Practice Address - Street 1:212 CORNELIA ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2306
Practice Address - Country:US
Practice Address - Phone:518-562-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY291399207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
010844308OtherFEDERAL TIN
VAH18056Medicare UPIN
NC2280742DMedicare ID - Type Unspecified
NC2280742DMedicare ID - Type Unspecified