Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0204X | Pediatric Emergency Doctor | 258633 | MA |
Y | 2080P0204X | Pediatric Emergency Doctor | 281156 | NY |
NPI | 1023270584 |
---|---|
Provider Name | Matthew D Thornton |
First Address | Syracuse, NY 13212-4516 |
Second Address | Syracuse, NY 13210-2306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2008 |
Last Update Date | 23/09/2015 |