Provider Demographics
NPI:1962427005
Name:MCCAUL, JENNIFER WEST (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:WEST
Last Name:MCCAUL
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 1:150 SIMS DR STE 201
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13244-4412
Mailing Address - Country:US
Mailing Address - Phone:315-443-8000
Mailing Address - Fax:315-443-9010
Practice Address - Street 1:150 SIMS DR STE 201
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13244-4412
Practice Address - Country:US
Practice Address - Phone:315-443-8000
Practice Address - Fax:315-443-9010
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2019-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237978207Q00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02800255Medicaid
NYRB2220Medicare PIN
NYP00383636Medicare PIN
NYI66838Medicare UPIN
NY02800255Medicaid