Provider Demographics
NPI:1255442497
Name:ONEONTA INTERNAL MEDICINE, PC
Entity type:Organization
Organization Name:ONEONTA INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SANTOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-432-7900
Mailing Address - Street 1:438 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2058
Mailing Address - Country:US
Mailing Address - Phone:607-432-7900
Mailing Address - Fax:607-432-7903
Practice Address - Street 1:438 MAIN ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2058
Practice Address - Country:US
Practice Address - Phone:607-432-7900
Practice Address - Fax:607-432-7903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
118416OtherMVP
BA0410Medicare ID - Type Unspecified