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General NPI Number Information
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NPI Number | 1477675106
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Entity Type | Organization
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Legal Business Name | CAPITAL DISTRICT PEDIATRICS, P.C.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2317 BALLTOWN RD SUITE 204 NORTH
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City | NISKAYUNA
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State | NY
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Zip | 12309-2339
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Country | US
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Telephone | 518-395-9215
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Fax |
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Provider Business Mailing Address
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Address Line | 2317 BALLTOWN RD SUITE 204 NORTH
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City | NISKAYUNA
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State | NY
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Zip | 12309-2339
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Country | US
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Telephone | 518-395-9215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMINA MIAN
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Credential | MD
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Telephone | 518-395-9215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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