Provider Demographics
NPI:1730170465
Name:DIANE M GEORGESON MD PC
Entity type:Organization
Organization Name:DIANE M GEORGESON MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GEORGESON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-431-2131
Mailing Address - Street 1:1 FOX CARE DR
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-2086
Mailing Address - Country:US
Mailing Address - Phone:607-431-2131
Mailing Address - Fax:607-431-2133
Practice Address - Street 1:1 FOX CARE DR
Practice Address - Street 2:SUITE 303
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2086
Practice Address - Country:US
Practice Address - Phone:607-431-2131
Practice Address - Fax:607-431-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00213504207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01953924Medicaid
C92705Medicare UPIN
DD5444Medicare ID - Type Unspecified