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General NPI Number Information
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NPI Number | 1568645083
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Entity Type | Individual
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Provider Name | MICHAEL CHARLES CONNELL P.A.
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Gender | Male
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Dates
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Enumeration Date | 12/06/2007
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3 IRONGATE CTR
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City | GLENS FALLS
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State | NY
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Zip | 12801-3471
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Country | US
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Telephone | 518-793-4409
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Fax | 518-615-0140
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Provider Business Mailing Address
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Address Line | 19 WEST AVE STE 103
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City | SARATOGA SPRINGS
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State | NY
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Zip | 12866-6052
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Country | US
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Telephone | 518-583-0111
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Fax | 518-583-2426
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002970
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License Number State | NY
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