Provider Demographics
NPI:1366582694
Name:PATSY M IANNOLO MD, PHD, P C
Entity type:Organization
Organization Name:PATSY M IANNOLO MD, PHD, P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:M
Authorized Official - Last Name:IANNOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-452-4622
Mailing Address - Street 1:5180 W TAFT RD
Mailing Address - Street 2:P O BOX 346
Mailing Address - City:N SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13212-2601
Mailing Address - Country:US
Mailing Address - Phone:315-458-4622
Mailing Address - Fax:315-458-9629
Practice Address - Street 1:5180 W TAFT RD
Practice Address - Street 2:
Practice Address - City:N SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13212-2601
Practice Address - Country:US
Practice Address - Phone:315-458-4622
Practice Address - Fax:315-458-9629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA1085Medicare PIN