Woglom, Russell Crockett

Woglom, Russell Crockett is an individual health care provider with primary practice located at 130 Center Way , Corning NY 14830-2255. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Woglom, Russell Crockett can be contacted via phone (607) 936-9971.

Contact Information

Primary practice address
130 Center Way Corning NY 14830-2255
Phone: (607) 936-9971
Fax: (607) 936-2600
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 170146-1 New York

Profile Details

NPI number 1417923434
LBN Legal business name Woglom, Russell Crockett
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 28th, 2006
Last updated Mar 3rd, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417923434 NPPES
New York Other 110224586 RR MEDICARE PIN
New York Other CC8362 RR MEDICARE PIN
New York MEDICAID 01030271 RR MEDICARE PIN
New York MEDICAID 0010940660003 RR MEDICARE PIN

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