Provider Demographics
NPI:1295710358
Name:DUFFY, JOHN SPARROW (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SPARROW
Last Name:DUFFY
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 1:39 WEST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:NY
Mailing Address - Zip Code:13617
Mailing Address - Country:US
Mailing Address - Phone:315-379-4700
Mailing Address - Fax:315-713-6512
Practice Address - Street 1:39 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:NY
Practice Address - Zip Code:13617
Practice Address - Country:US
Practice Address - Phone:315-379-4700
Practice Address - Fax:315-713-6512
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY284577207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04392256Medicaid
NC2021566COtherMEDICARE PTAN
NC891357VMedicaid
NCP00357480Medicare PIN
NC891357VMedicaid