Healthcare Provider Details

I. General information

NPI: 1427100262
Provider Name (Legal Business Name): MOUNTAIN MEDICAL PRIMARY CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1927 SARANAC AVE
LAKE PLACID NY
12946-1172
US

IV. Provider business mailing address

1927 SARANAC AVE
LAKE PLACID NY
12946-1112
US

V. Phone/Fax

Practice location:
  • Phone: 518-523-7575
  • Fax:
Mailing address:
  • Phone: 518-523-7575
  • Fax: 518-523-7577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL POND
Title or Position: OWNER
Credential: MD
Phone: 518-523-7575