Healthcare Provider Details

I. General information

NPI: 1932281524
Provider Name (Legal Business Name): CAPITAL DISTRICT DERMATOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 ROUTE 9W
GLENMONT NY
12077-3327
US

IV. Provider business mailing address

450 ROUTE 9W
GLENMONT NY
12077-3327
US

V. Phone/Fax

Practice location:
  • Phone: 518-434-8121
  • Fax: 518-426-0620
Mailing address:
  • Phone: 518-434-8121
  • Fax: 518-426-0620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEROME HILL
Title or Position: MD
Credential:
Phone: 518-434-8121