Healthcare Provider Details

I. General information

NPI: 1508915661
Provider Name (Legal Business Name): AGNES A. GELDER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 BLOOMINGROVE DR
TROY NY
12180-8552
US

IV. Provider business mailing address

3 SUNRISE TER
WYNANTSKILL NY
12198-2821
US

V. Phone/Fax

Practice location:
  • Phone: 518-283-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number217349
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: