Basic Information
| Provider Information | |||||||||
| NPI: | 1972501682 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PRYCE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 134 HOMER AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077588019 | ||||||||
| FaxNumber: | 6077588210 | ||||||||
| Practice Location | |||||||||
| Address1: | 1104 COMMONS AVE | ||||||||
| Address2: | |||||||||
| City: | CORTLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130451643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6077583750 | ||||||||
| FaxNumber: | 6077583754 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 05/01/2018 | ||||||||
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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 | 204C00000X | 35-04-2582-P | OH | N | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | 204C00000X | 280178 | NY | Y | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine |
ID Information
| ID | Type | State | Issuer | Description | 04236155 | 05 | NY | MEDICAID | 34-1522369 | 01 | OH | FEDERAL TAX ID # | OTHER | 34152236900 | 01 | OH | WORKERS COMP. # | OTHER | 0548401 | 05 | OH | MEDICAID |