Basic Information
| Provider Information | |||||||||
| NPI: | 1619400967 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MESERVE | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17 MAIN ST | ||||||||
| Address2: | |||||||||
| City: | QUEENSBURY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 128044007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187980767 | ||||||||
| FaxNumber: | 5187980815 | ||||||||
| Practice Location | |||||||||
| Address1: | 15 DEGRANDPRE WAY | ||||||||
| Address2: | |||||||||
| City: | PLATTSBURGH | ||||||||
| State: | NY | ||||||||
| PostalCode: | 129016449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5187980767 | ||||||||
| FaxNumber: | 5186365979 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2017 | ||||||||
| LastUpdateDate: | 10/28/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 318576 | NY | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.