Provider Demographics
NPI:1912995978
Name:HURLEY, ROSEMARIE (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARIE
Middle Name:
Last Name:HURLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4077 STATE ROUTE 281
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1637
Mailing Address - Country:US
Mailing Address - Phone:607-753-9977
Mailing Address - Fax:607-753-7311
Practice Address - Street 1:4077 STATE ROUTE 281
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1637
Practice Address - Country:US
Practice Address - Phone:607-753-9977
Practice Address - Fax:607-753-7311
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00891823Medicaid
NY53606HMedicare UPIN
NY00891823Medicaid