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General NPI Number Information
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NPI Number | 1679950430
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Entity Type | Organization
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Legal Business Name | BEAUMONT GASTROENTEROLOGY SERVICES
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 06/01/2015
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Provider Practice Location Address
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Address Line | 14 DURKEE ST SUITE 125
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City | PLATTSBURGH
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State | NY
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Zip | 12901-2989
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Country | US
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Telephone | 518-310-3890
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Fax | 518-536-9066
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Provider Business Mailing Address
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Address Line | 168 US OVAL
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City | PLATTSBURGH
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State | NY
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Zip | 12903-3900
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Country | US
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Telephone | 518-310-3890
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PAOLO FEDI
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Credential | M.D.
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Telephone | 518-561-8679
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 230138
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License Number State | NY
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