Provider Demographics
NPI:1477506996
Name:OSWEGO FAMILY PHYSICIANS, PC
Entity type:Organization
Organization Name:OSWEGO FAMILY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-342-2024
Mailing Address - Street 1:110 W UTICA ST
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-3057
Mailing Address - Country:US
Mailing Address - Phone:315-342-2024
Mailing Address - Fax:315-343-5317
Practice Address - Street 1:110 W UTICA ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3057
Practice Address - Country:US
Practice Address - Phone:315-342-2024
Practice Address - Fax:315-343-5317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY160648170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01061009Medicaid
NY01061009Medicaid
NY51408BMedicare ID - Type Unspecified