| Carmen Bautista-dator Md Pc | |
|
177 W 4th St Oswego NY 13126-3009 | |
| (315) 343-2151 | |
| (315) 343-2100 |
| Full Name | Carmen Bautista-dator Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 177 W 4th St, Oswego, New York |
| Authorized Official Name and Position | Carmen Bautista Dator (PHYSICIAN) |
| Authorized Official Contact | 3153432151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carmen Bautista-dator Md Pc 177 W 4th St Oswego NY 13126-3009 Ph: (315) 343-2151 | Carmen Bautista-dator Md Pc 177 W 4th St Oswego NY 13126-3009 Ph: (315) 343-2151 |
| NPI Number | 1912066242 |
|---|---|
| Provider Enumeration Date | 12/06/2006 |
| Last Update Date | 05/20/2008 |
| Medicare PECOS PAC ID | 4688617764 |
|---|---|
| Medicare Enrollment ID | O20050609000362 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912066242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2300280 (New York) | Primary |
| Provider Name | Carmen S Bautista-dator |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1346267291 PECOS PAC ID: 2769470335 Enrollment ID: I20040503001288 |
| Provider Name | Carlos O Dator |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114287158 PECOS PAC ID: 2163732116 Enrollment ID: I20151104000984 |
| Provider Name | Nicci L Nelson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851878532 PECOS PAC ID: 9830449800 Enrollment ID: I20180912002815 |
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