Healthcare Provider Details

I. General information

NPI: 1376586735
Provider Name (Legal Business Name): JUAN CARLOS GARCIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/10/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 PARK ST SUITE 202
GLENS FALLS NY
12801-4449
US

IV. Provider business mailing address

102 PARK ST SUITE 202, PO BOX 787
GLENS FALLS NY
12801-4449
US

V. Phone/Fax

Practice location:
  • Phone: 518-793-0475
  • Fax: 518-793-6658
Mailing address:
  • Phone: 518-793-0475
  • Fax: 518-793-6658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number230363
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number230363-1
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number230363-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: