Healthcare Provider Details

I. General information

NPI: 1447355896
Provider Name (Legal Business Name): TRI-COUNTY MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 WEST MAIN STREET
LITTLE FALLS NY
13365
US

IV. Provider business mailing address

175 WEST MAIN STREET
LITTLE FALLS NY
13365
US

V. Phone/Fax

Practice location:
  • Phone: 315-823-4111
  • Fax: 315-823-1889
Mailing address:
  • Phone: 315-823-4111
  • Fax: 315-823-1889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number166837
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number166837
License Number StateNY

VIII. Authorized Official

Name: DR. DEEPAK D BUCH
Title or Position: OWNER
Credential: MD
Phone: 315-823-4111