DR. RUSSELL CROCKETT WOGLOM (NPI# 1417923434) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417923434 |
| Entity Type | Individual |
| Full Name | DR. RUSSELL CROCKETT WOGLOM |
| Credential | MD |
| Practice Address |
130 Center Way Corning NY 14830-2255 |
| Mailing Address |
1 Guthrie Sq Sayre PA 18840-1625 |
| Practice Telephone | 6079369971 |
| Practice Fax Number | 6079362600 |
| Mailing Telephone | 5708885858 |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2011-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207R00000X | Internal Medicine | 170146-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | RR MEDICARE GROUP | CC8362 | 01 |
| PA | 0010940660003 | 05 | |
| NY | 01030271 | 05 | |
| NY | RR MEDICARE PIN | 110224586 | 01 |
| Street Address |
130 CENTER WAY |
| City | CORNING |
| State | NY |
| Zip Code | 14830-2255 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144227299 | Edward V Cordes | Optometrist | 130 Center Way, Corning, NY 14830-2255 | 2005-07-05 |
| 1639720873 | Patricia Anne Youngs | Nurse Practitioner | 130 Center Way, Corning, NY 14830-2287 | 2019-09-27 |
| 1386297745 | Christine Elizabeth Krohmalney | Nurse Practitioner | 130 Center Way, Corning, NY 14830-2255 | 2019-07-24 |
| 1194266163 | Jennifer Cornish | Registered Nurse | 130 Center Way, Corning, NY 14830-2255 | 2017-03-10 |
| 1386092641 | Jamie Alison Pace | Nurse Practitioner | 130 Center Way, Corning, NY 14830-2255 | 2016-05-27 |
| 1568849693 | Deepa Manimegalan | Pediatrics | 130 Center Way, Corning, NY 14830-2255 | 2015-04-27 |
| 1215330709 | Talia Calabro | Physician Assistant | 130 Center Way, Corning, NY 14830-2255 | 2014-09-29 |
| 1457776395 | Sisay Akalu | Preventive Medicine | 130 Center Way, Corning, NY 14830 | 2014-03-01 |
| 1144656091 | Guthrie Health | Durable Medical Equipment & Medical Supplies | 130 Center Way, Corning, NY 14830-2255 | 2013-09-24 |
| 1710327796 | Mireille Taufik | Family Medicine | 130 Center Way, Corning, NY 14830-2255 | 2013-07-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295358836 | Shehla Javed | Registered Nurse | 3 Corning Dr, Corning, NY 14830 | 2020-05-18 |
| 1285993246 | Karen Adams | Physical Therapy Assistant | 205 E. First, Corning, NY 14830 | 2012-05-11 |
| 1275802464 | Anne Bethany Stefanini | Registered Nurse | 36 Mcmahon Avenue, Corning, NY 14830 | 2011-12-19 |
| 1548538119 | Elizabeth Ruth Costello | Registered Nurse | 11 West Third Street, Corning Free Academy, Corning, NY 14830 | 2011-12-09 |
| 1760769418 | Elizabeth Regina Feulner | Registered Nurse | 143 Princton Ave, Northside Blodgett Middle School, Corning, NY 14830 | 2011-11-09 |
| 1073823423 | Joyce Berliner | Occupational Therapist | 33 Denison Parkway West, Corning, NY 14830 | 2010-10-19 |
| 1285880625 | Angie L. Degraff-dacey | Licensed Practical Nurse | 160 Florentia Ln E, Corning, NY 14830 | 2008-08-18 |
| 1003098393 | Marcia Louise Ritter | Pharmacist | 601 West Pulteney Street, Corning, NY 14830 | 2007-11-29 |
| 1023203247 | Suzan S Fenstermacher | Physician Assistant | 88 Tioga Ave., Suite 102, Corning, NY 14830 | 2007-09-11 |
| 1205047313 | Katherine Ann Colyer | Physical Therapist | 11849 East Corning Rd, Suite 108, Corning, NY 14830 | 2007-05-24 |
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| Taxonomy Code | 207R00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639304876 | Shreelakshmi Ramaswamy | Internal Medicine | 8 Denison Pkwy E Ste 201, Corning, NY 14830-2636 | 2009-05-18 |
| 1922123629 | James Leo Schuppert | Internal Medicine | 88 Tioga Ave, Corning, NY 14831-0001 | 2007-03-20 |
| 1497770176 | Steven Allen Freeman | Internal Medicine | 601 Rosary Dr, Corning, IA 50841-1683 | 2006-07-13 |
| 1861435620 | Roopa Jagadeesh Hathwar | Internal Medicine | 8 Denison Pkwy E, Suite 201, Corning, NY 14830-2638 | 2006-06-13 |
| 1952373532 | Cynthia A Silvestre | Internal Medicine | 1300 Creason Rd, Corning, AR 72422-1716 | 2006-02-07 |
| 1831577071 | Zacchaeus Akinleye | Internal Medicine | 1 Guthrie Dr, Corning, NY 14830 | 2015-05-07 |
| 1912302035 | Patrick W. Horner | Internal Medicine | 1 Guthrie Dr, Corning, NY 14830 | 2014-10-31 |
| 1013215896 | Michael Jon Depersis | Internal Medicine | 1 Guthrie Dr, Guthrie Medical Group, Corning, NY 14830-3696 | 2011-03-03 |
| 1922266634 | Teofilo Juan Carlos Arazi | Internal Medicine | 176 Denison Pkwy E, Corning, NY 14830-2814 | 2008-05-29 |
| 1164610820 | Aref Sobhani-mahdabi | Internal Medicine | 176 Denison Pkwy E, Corning, NY 14830-2814 | 2007-10-09 |
| Find all providers in CORNING | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.