Provider Demographics
NPI:1962985564
Name:CMA MEDICAL PRACTICE PLLC
Entity type:Organization
Organization Name:CMA MEDICAL PRACTICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STALLONE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-274-4322
Mailing Address - Street 1:PO BOX 795
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851-0795
Mailing Address - Country:US
Mailing Address - Phone:855-691-9890
Mailing Address - Fax:781-276-6403
Practice Address - Street 1:101 DATES DR
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1342
Practice Address - Country:US
Practice Address - Phone:607-274-4011
Practice Address - Fax:607-252-3051
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAYUGA MEDICAL ASSOCIATES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-10
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty