Healthcare Provider Details

I. General information

NPI: 1548480551
Provider Name (Legal Business Name): PRIME CARE PHYSICIANS, P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 WESTERN AVE SUITE B-2
ALBANY NY
12203-3440
US

IV. Provider business mailing address

4 ATRIUM DR SUITE 100
ALBANY NY
12205-1441
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-8014
  • Fax: 518-533-6714
Mailing address:
  • Phone: 518-435-2704
  • Fax: 518-458-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number54964
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number54964
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number54964
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number54964
License Number StateNY

VIII. Authorized Official

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