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General NPI Number Information
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NPI Number | 1972296630
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Entity Type | Organization
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Legal Business Name | CARONDELET REGIONAL MEDICAL, PC
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Dates
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Enumeration Date | 05/30/2023
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Last Update Date | 05/30/2023
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Provider Practice Location Address
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Address Line | 3768 STATE HIGHWAY 30
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City | BROADALBIN
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State | NY
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Zip | 12025-0923
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Country | US
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Telephone | 518-883-3121
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Fax | 518-883-8268
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Provider Business Mailing Address
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Address Line | 3768 STATE HIGHWAY 30
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City | BROADALBIN
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State | NY
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Zip | 12025-0923
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Country | US
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Telephone | 518-883-3121
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Fax | 518-883-8268
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | RONALD N MARSH
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Credential | MD
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Telephone | 518-843-6914
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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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