Healthcare Provider Details

I. General information

NPI: 1689678930
Provider Name (Legal Business Name): DONALD R MORERE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2005
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

848 ROUTE 50
BURNT HILLS NY
12027
US

IV. Provider business mailing address

848 ROUTE 50
BURNT HILLS NY
12027-9511
US

V. Phone/Fax

Practice location:
  • Phone: 518-831-1500
  • Fax: 518-280-8464
Mailing address:
  • Phone: 518-831-1500
  • Fax: 518-280-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number154613
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: