Provider Demographics
NPI:1730250697
Name:WASCO, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WASCO
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 1:276-280 ROBINSON ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13904-1659
Mailing Address - Country:US
Mailing Address - Phone:607-722-2769
Mailing Address - Fax:607-772-2095
Practice Address - Street 1:276-280 ROBINSON ST
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13904-1659
Practice Address - Country:US
Practice Address - Phone:607-722-2769
Practice Address - Fax:607-772-2095
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129445207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00522409Medicaid
NY00522409Medicaid
NYL70170Medicare ID - Type Unspecified