MEDICARE: PRIME CARE PHYSICIANS, P.L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RS0010X	Sports Medicine (Internal Medicine) Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124013040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME CARE PHYSICIANS, P.L.L.C.

Provider Business Mailing Address
First Line	:	17 GLENN POND ROAD
Second Line	:	SUITE 3
City	:	RED HOOK
State	:	NY
Zip	:	12571-1824
Country	:	US
Telephone Number	:	845-758-6046
Fax Number	:	845-758-6051

Provider Business Practice Location Address
First Line	:	17 GLENN POND ROAD
Second Line	:	SUITE 3
City	:	RED HOOK
State	:	NY
Zip	:	12571-1824
Country	:	US
Telephone Number	:	845-758-6046
Fax Number	:	845-758-6051

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. ANGELA C CAVANNA
Credential	:	DO
Telephone Number	:	845-758-6046

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	03/28/2012

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Directions to “PRIME CARE PHYSICIANS, P.L.L.C. ” Practice Location

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