=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578783114
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE-CAROLINE PICHE M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/26/2007
-----------------------------------------------------
Last Update Date | 06/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 PARK ST
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12953-1220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-483-3000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 718 WEBSTER ST
-----------------------------------------------------
City | MALONE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12953-3603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-481-5769
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QH0002X
-----------------------------------------------------
Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
-----------------------------------------------------
License Number | 244201
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------