Provider Demographics
NPI:1215964051
Name:WESTLAKE, ROBERT ELMER JR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ELMER
Last Name:WESTLAKE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1001 W FAYETTE STREET
Mailing Address - Street 2:STE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204
Mailing Address - Country:US
Mailing Address - Phone:315-472-1488
Mailing Address - Fax:315-476-1792
Practice Address - Street 1:5700 W GENESEE ST
Practice Address - Street 2:SUITE 201N
Practice Address - City:CAMILLUS
Practice Address - State:NY
Practice Address - Zip Code:13031-3200
Practice Address - Country:US
Practice Address - Phone:315-488-1438
Practice Address - Fax:315-468-0792
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2015-01-16
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Provider Licenses
StateLicense IDTaxonomies
NY137940207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00562583Medicaid
NY53770CMedicare PIN
B81672Medicare UPIN
NY110068630Medicare PIN