Provider Demographics
NPI:1386739092
Name:DEAN, GARY D (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:DEAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3101 SHIPPERS RD
Mailing Address - Street 2:STE 203
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2082
Mailing Address - Country:US
Mailing Address - Phone:607-786-4822
Mailing Address - Fax:607-786-3837
Practice Address - Street 1:105 RIDGEHAVEN DR
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2640
Practice Address - Country:US
Practice Address - Phone:607-786-4822
Practice Address - Fax:607-786-3837
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2021-03-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY151253207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00862859Medicaid
NYB81860Medicare UPIN
NY00862859Medicaid