Healthcare Provider Details

I. General information

NPI: 1285627075
Provider Name (Legal Business Name): PRIME CARE PHYSICIANS, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 ATRIUM DR SUITE 100
ALBANY NY
12205-1441
US

IV. Provider business mailing address

4 ATRIUM DR SUITE 100
ALBANY NY
12205-1441
US

V. Phone/Fax

Practice location:
  • Phone: 518-435-2704
  • Fax: 518-458-2610
Mailing address:
  • Phone: 518-435-2704
  • Fax: 518-458-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20913
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20913
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number20913
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number20913
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number20913
License Number StateNY
# 6
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number20913
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20913
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number20913
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number20913
License Number StateNY
# 10
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20913
License Number StateNY
# 11
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number20913
License Number StateNY
# 12
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number20913
License Number StateNY
# 13
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number20913
License Number StateNY
# 14
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number20913
License Number StateNY
# 15
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number20913
License Number StateNY

VIII. Authorized Official

Name: MR. MICHAEL WHALEN
Title or Position: DIRECTOR OF ADMINISTRATION
Credential:
Phone: 518-435-2704