| Progressive Medicine of Ithaca, PC | |
|
402 3rd Street Suite 2 Ithaca NY 14850 | |
| (607) 272-9938 | |
| (607) 272-9996 |
| Full Name | Progressive Medicine of Ithaca, PC |
|---|---|
| Speciality | Family Medicine |
| Location | 402 3rd Street, Ithaca, New York |
| Authorized Official Name and Position | John W Weston (OWNER) |
| Authorized Official Contact | 6072729938 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Progressive Medicine of Ithaca, PC 402 3rd Street Suite 2 Ithaca NY 14850 Ph: (607) 272-9938 | Progressive Medicine of Ithaca, PC 402 3rd Street Suite 2 Ithaca NY 14850 Ph: (607) 272-9938 |
| NPI Number | 1467621797 |
|---|---|
| Provider Enumeration Date | 02/20/2008 |
| Last Update Date | 05/01/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467621797 | NPI | - | NPPES |
| 02383448 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 224502 (New York) | Primary |
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