1295700862 NPI number — DR. MARCIS TOTS SODUMS MD

Table of content: DR. MARCIS TOTS SODUMS MD (NPI 1295700862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295700862 NPI number — DR. MARCIS TOTS SODUMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SODUMS
Provider First Name:
MARCIS
Provider Middle Name:
TOTS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1295700862
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 TRUMANSBURG RD
Provider Second Line Business Mailing Address:
SUITE P
Provider Business Mailing Address City Name:
ITHACA
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14850-1397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-277-2365
Provider Business Mailing Address Fax Number:
607-277-0104

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
310 TAUGHANNOCK BLVD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
ITHACA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14850-3251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-269-0100
Provider Business Practice Location Address Fax Number:
607-269-0177
Provider Enumeration Date:
02/17/2006

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: 207RC0000X , with the licence number:  MD036869E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: MD036869E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 154828-1 , 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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