Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 155383 | NY |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | 155383 | NY |
NPI | 1770571101 |
---|---|
Provider Name | Suzanne Kochweser Anderson |
First Address | Trumansburg, NY 14886-9201 |
Second Address | Trumansburg, NY 14886-9201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 03/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00917208 | (05) | NY |
E15544 | (02) |