MEDICARE: DR. NANCY A GIRARD DO

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	207Q00000X	Family Medicine Physician	188587	NY

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
2	J300073782	OTHER	NY	PTAN

General Provider Information

NPI Number	:	1689673378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY A GIRARD DO

Provider Business Mailing Address
First Line	:	2 MARKET ST
Second Line	:	POB 129
City	:	ALEXANDRIA BAY
State	:	NY
Zip	:	13607-1317
Country	:	US
Telephone Number	:	315-482-5404
Fax Number	:	315-482-6265

Provider Business Practice Location Address
First Line	:	2 MARKET ST
Second Line	:	POB 129
City	:	ALEXANDRIA BAY
State	:	NY
Zip	:	13607-1317
Country	:	US
Telephone Number	:	315-482-5404
Fax Number	:	315-482-6265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/25/2012

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