Provider Demographics
NPI:1285763912
Name:CHAMPLAIN PAIN RELIEF AND NEUROLOGY, PLLC
Entity type:Organization
Organization Name:CHAMPLAIN PAIN RELIEF AND NEUROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:CELESTE
Authorized Official - Last Name:GAUGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-566-8603
Mailing Address - Street 1:159 MARGARET STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901
Mailing Address - Country:US
Mailing Address - Phone:518-566-8603
Mailing Address - Fax:518-566-8582
Practice Address - Street 1:159 MARGARET STREET
Practice Address - Street 2:SUITE 500
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901
Practice Address - Country:US
Practice Address - Phone:518-566-8603
Practice Address - Fax:518-566-8582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2133082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY698338OtherMVP
NY130023170OtherRRMCR
NY2033749OtherAETNA
NYP010213308OtherEXCELLUS BC BS
NY000495471003OtherBLUE SHIELD OF NENY
NY01998998Medicaid
NY110639300OtherUSDOL
NY8C1231OtherBLUE CROSS BLUE SHIELD
NY110639300OtherUSDOL
NY130023170OtherRRMCR
NYNYBU16502Medicare Oscar/Certification