Provider Demographics
NPI:1184971897
Name:BETH HOUCK MD LLC
Entity type:Organization
Organization Name:BETH HOUCK MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-671-5310
Mailing Address - Street 1:475 IRVING AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1756
Mailing Address - Country:US
Mailing Address - Phone:315-671-5310
Mailing Address - Fax:315-671-5304
Practice Address - Street 1:475 IRVING AVE
Practice Address - Street 2:SUITE 406
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1756
Practice Address - Country:US
Practice Address - Phone:315-671-5310
Practice Address - Fax:315-671-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY186424207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY738768Medicare UPIN