Healthcare Provider Details

I. General information

NPI: 1942255930
Provider Name (Legal Business Name): CAPITAL UROLOGY CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVE SUITE 102
ALBANY NY
12206-1098
US

IV. Provider business mailing address

205 N PEARL ST
ALBANY NY
12207-2309
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-6468
  • Fax: 518-489-6471
Mailing address:
  • Phone: 518-598-0778
  • Fax: 518-489-6471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number121265
License Number StateNY

VIII. Authorized Official

Name: DR. DONALD J RIVARD
Title or Position: MD/OWNER
Credential: M.D.
Phone: 518-598-0778