Healthcare Provider Details

I. General information

NPI: 1851325385
Provider Name (Legal Business Name): PAUL MARKESSINIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 CAREY RD
QUEENSBURY NY
12804-7821
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-824-8610
  • Fax: 518-824-2390
Mailing address:
  • Phone: 518-761-0300
  • Fax: 518-745-1378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number159901
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: