Basic Information
| Provider Information | |||||||||
| NPI: | 1750310645 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PROVIDENT EMERGENCY MEDICINE ASSOCIATES, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1597 | ||||||||
| Address2: | 428 CLIFTON CORPORATE PARK | ||||||||
| City: | CLIFTON PARK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120650807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183835450 | ||||||||
| FaxNumber: | 5183834223 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 MCCLELLAN ST | ||||||||
| Address2: | @ ST. CLARE'S HOSPITAL ER DEPT | ||||||||
| City: | SCHENECTADY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 123041009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183835450 | ||||||||
| FaxNumber: | 5183834223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 05/27/2008 | ||||||||
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| AuthorizedOfficialLastName: | BARROWMAN | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5183835450 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.