Basic Information
| Provider Information | |||||||||
| NPI: | 1982094827 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SARATOGA REGIONAL MEDICAL , P.C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 10008 | ||||||||
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| City: | ALBANY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 122015008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183481276 | ||||||||
| FaxNumber: | 5183481279 | ||||||||
| Practice Location | |||||||||
| Address1: | 2911 ROUTE 9 | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | BALLSTON SPA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120203975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5183638815 | ||||||||
| FaxNumber: | 5183638831 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2015 | ||||||||
| LastUpdateDate: | 02/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | METHVEN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5185802135 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.