Basic Information
| Provider Information | |||||||||
| NPI: | 1548437296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARANOV | ||||||||
| FirstName: | DMITRI | ||||||||
| MiddleName: | V | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 WEST AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128666045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186934699 | ||||||||
| FaxNumber: | 5185843016 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 WEST AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | SARATOGA SPRINGS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128666045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186934699 | ||||||||
| FaxNumber: | 5185843016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2008 | ||||||||
| LastUpdateDate: | 03/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 235972 | MA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 253821 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.