Healthcare Provider Details

I. General information

NPI: 1437183183
Provider Name (Legal Business Name): DARCI A GAIOTTI-GRUBBS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 06/29/2021
Certification Date: 06/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST CR WOOD CANCER CENTER
GLENS FALLS NY
12801-4449
US

IV. Provider business mailing address

100 PARK STREET GLENS FALLS HOSPITAL - CREDENTIALING
GLENS FALLS NY
12801-4413
US

V. Phone/Fax

Practice location:
  • Phone: 518-926-6620
  • Fax: 518-926-1954
Mailing address:
  • Phone: 518-926-5924
  • Fax: 518-926-6983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number252440
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: