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General NPI Number Information
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NPI Number | 1699876482
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Entity Type | Organization
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Legal Business Name | NORTH COUNTRY HEALTH CARE, MEDICAL PLLC
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Dates
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Enumeration Date | 09/26/2006
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Last Update Date | 04/20/2009
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Provider Practice Location Address
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Address Line | 24 4TH ST
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City | MALONE
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State | NY
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Zip | 12953-1350
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Country | US
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Telephone | 518-481-6044
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Fax | 518-481-6043
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Provider Business Mailing Address
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Address Line | 24 4TH ST
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City | MALONE
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State | NY
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Zip | 12953-1350
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Country | US
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Telephone | 518-481-6044
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Fax | 518-481-6043
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | MR. VLADIMR MEDVED
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Credential | D.O.
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Telephone | 518-481-6044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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