Provider Demographics
NPI:1447509112
Name:JOHN R. WANAMAKER, MD PC
Entity type:Organization
Organization Name:JOHN R. WANAMAKER, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:WANAMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-632-7000
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:STE 3A
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-632-7000
Mailing Address - Fax:315-632-7010
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:STE 3A
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-632-7000
Practice Address - Fax:315-632-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY980213000640207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty