Healthcare Provider Details

I. General information

NPI: 1770558652
Provider Name (Legal Business Name): JOHN MICHAEL PURCELL SR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 ROUTE 9
CLIFTON PARK NY
12065-5669
US

IV. Provider business mailing address

818 WASHINGTON AVE
ALBANY NY
12203
US

V. Phone/Fax

Practice location:
  • Phone: 518-482-1515
  • Fax: 518-383-3376
Mailing address:
  • Phone: 518-482-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number099499
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: