Basic Information
| Provider Information | |||||||||
| NPI: | 1427028117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCGINNIS | ||||||||
| FirstName: | KERMIT | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 202 TAUGHANNOCK BLVD | ||||||||
| Address2: | PO BOX 366 | ||||||||
| City: | ITHACA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 148503328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072774035 | ||||||||
| FaxNumber: | 6072773888 | ||||||||
| Practice Location | |||||||||
| Address1: | 196 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | GENEVA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 144561651 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157874533 | ||||||||
| FaxNumber: | 3157874469 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 235789 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 02660295 | 05 | NY | MEDICAID |