1073535696 NPI number — DR. CATHERINE M. VERNON MD, PHD

Table of content: DR. CATHERINE M. VERNON MD, PHD (NPI 1073535696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073535696 NPI number — DR. CATHERINE M. VERNON MD, PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERNON
Provider First Name:
CATHERINE
Provider Middle Name:
M.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073535696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
119 SNOWBERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMILLUS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13031-8697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-672-8228
Provider Business Mailing Address Fax Number:
315-425-2489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 IRVING AVE
Provider Second Line Business Practice Location Address:
VAMC SYRACUSE
Provider Business Practice Location Address City Name:
SYRACUSE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13210-2716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-425-4400
Provider Business Practice Location Address Fax Number:
315-425-2489
Provider Enumeration Date:
07/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  175891-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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