Healthcare Provider Details

I. General information

NPI: 1407923873
Provider Name (Legal Business Name): CAPITAL DISTRICT PEDIATRIC CARDIOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MANNING BLVD SUITE 203
ALBANY NY
12208
US

IV. Provider business mailing address

319 S MANNING BLVD SUITE 203
ALBANY NY
12208
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-3292
  • Fax: 518-453-6286
Mailing address:
  • Phone: 518-489-3292
  • Fax: 518-453-6286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC W SPOONER
Title or Position: PRESIDENT
Credential:
Phone: 518-489-3292