| Adult Primary Care Of Fayetteville | |
|
212 Highbridge St Suite C Fayetteville NY 13066-1979 | |
| (315) 637-0477 | |
| Not Available |
| Full Name | Adult Primary Care Of Fayetteville |
|---|---|
| Speciality | Internal Medicine |
| Location | 212 Highbridge St, Fayetteville, New York |
| Authorized Official Name and Position | John Michael Callahan (SOLE PROPRIETOR) |
| Authorized Official Contact | 3156370477 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Adult Primary Care Of Fayetteville 212 Highbridge St Suite C Fayetteville NY 13066-1979 Ph: (315) 637-0477 | Adult Primary Care Of Fayetteville 212 Highbridge St Suite C Fayetteville NY 13066-1979 Ph: (315) 637-0477 |
| NPI Number | 1013086404 |
|---|---|
| Provider Enumeration Date | 11/07/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013086404 | NPI | - | NPPES |
| 1936736 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 208546 (New York) | Primary |
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