Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 220490-1 | NY |
N | 111NI0900X | Internist | 220490-1 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 220490 | NY |
NPI | 1861498602 |
---|---|
Provider Name | Dr. John-Paul Daniel Mead |
First Address | Syracuse, NY 13204-2859 |
Second Address | Ithaca, NY 14850-1342 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2005 |
Last Update Date | 23/05/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02161659 | (05) | NY |
H36901 | (02) | NY |