=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669289906
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SARATOGA REGIONAL MEDICAL , P.C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/11/2024
-----------------------------------------------------
Last Update Date | 12/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3050 ROUTE 50 STE 201
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-2964
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-587-3222
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 211 CHURCH ST
-----------------------------------------------------
City | SARATOGA SPRINGS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12866-1090
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-886-5296
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | ROBERT DONNARUMMA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 518-587-1141
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------