| Roger B Shambo, Md, Llc | |
|
9732 State Route 12 Copenhagen NY 13626-0026 | |
| (315) 688-2305 | |
| (315) 688-2139 |
| Full Name | Roger B Shambo, Md, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 9732 State Route 12, Copenhagen, New York |
| Authorized Official Name and Position | Roger B Shambo (OWNER) |
| Authorized Official Contact | 3156882305 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Roger B Shambo, Md, Llc 9732 State Route 12 Po Box 26 Copenhagen NY 13626-0026 Ph: (315) 688-2305 | Roger B Shambo, Md, Llc 9732 State Route 12 Copenhagen NY 13626-0026 Ph: (315) 688-2305 |
| NPI Number | 1215133491 |
|---|---|
| Provider Enumeration Date | 06/25/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215133491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 165521 (New York) | Primary |
Lewis County General Hospital Primary Care Clinic Medicare: Medicare Enrolled Practice Location: Copenhagen Health Center, 9732 State Route 12, Copenhagen, NY 13626 Phone: 315-688-2305 |