Provider Demographics
NPI:1386605848
Name:WIGHT, JOHN A (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:A
Last Name:WIGHT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3 CURTIS RD
Mailing Address - Street 2:
Mailing Address - City:VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:13476-3607
Mailing Address - Country:US
Mailing Address - Phone:315-829-2220
Mailing Address - Fax:315-829-3955
Practice Address - Street 1:3 CURTIS RD
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:NY
Practice Address - Zip Code:13476-3607
Practice Address - Country:US
Practice Address - Phone:315-829-2220
Practice Address - Fax:315-829-3955
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY157905207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01001069Medicaid
NY101001069Medicaid
NY55385BMedicare ID - Type Unspecified
NY01001069Medicaid