Healthcare Provider Details

I. General information

NPI: 1750476503
Provider Name (Legal Business Name): WILLIAM A GRATTAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MOHAWK STREET SUITE 101
COHOES NY
12047
US

IV. Provider business mailing address

55 MOHAWK STREET SUITE 101
COHOES NY
12047
US

V. Phone/Fax

Practice location:
  • Phone: 518-233-9500
  • Fax: 518-235-4827
Mailing address:
  • Phone: 518-233-9500
  • Fax: 518-235-4827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number076202
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberF380828
License Number StateNY

VIII. Authorized Official

Name: DR. WILLIAM ANTHONY GRATTON
Title or Position: PRESIDENT PEDIATRICIAN
Credential: MD
Phone: 518-233-9500