Provider Demographics
NPI:1659106805
Name:JOHN-PAUL MEAD, M.D., PLLC
Entity type:Organization
Organization Name:JOHN-PAUL MEAD, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN-PAUL
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:MEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-216-0532
Mailing Address - Street 1:103 W SENECA ST STE 302
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4157
Mailing Address - Country:US
Mailing Address - Phone:607-216-0532
Mailing Address - Fax:607-339-0062
Practice Address - Street 1:103 W SENECA ST STE 302
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4157
Practice Address - Country:US
Practice Address - Phone:607-216-0532
Practice Address - Fax:607-339-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-06
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty