Provider Demographics
NPI:1306139332
Name:PURCELL, MICHAEL W (DO)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:PURCELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1462 ERIE BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1026
Mailing Address - Country:US
Mailing Address - Phone:518-901-2800
Mailing Address - Fax:518-240-4347
Practice Address - Street 1:1462 ERIE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-1026
Practice Address - Country:US
Practice Address - Phone:518-901-2800
Practice Address - Fax:518-240-4347
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY293722207R00000X, 208000000X
PAOS017574208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS017574OtherPA LICENSE
PA1030606220004Medicaid