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NPI Code Detail

MEDICARE: SAND CREEK MEDICAL PC

MEDICARE: SAND CREEK MEDICAL PC
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
1174400000XSpecialist115905NY

General Provider Information

NPI Number : 1275624900
Entity Type Code : Organization
Provider Name (Legal Business Name) : SAND CREEK MEDICAL PC
Provider Business Mailing Address
First Line : 116 EVERETT RD
Second Line :
City : ALBANY
State : NY
Zip : 12205-1427
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 116 EVERETT RD
Second Line :
City : ALBANY
State : NY
Zip : 12205-1427
Country : US
Telephone Number : 518-437-1200
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : BASAVARAJA OREKONDY
Credential : MD
Telephone Number : 518-437-1200
Provider Enumeration Date : 09/27/2006
Last Update Date : 08/22/2020

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Directions to “SAND CREEK MEDICAL PC ” Practice Location

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