Provider Demographics
NPI:1427143460
Name:PRIMARILY FOR WOMEN MEDICAL PRACTICE PLLC
Entity type:Organization
Organization Name:PRIMARILY FOR WOMEN MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GATH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-435-1123
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1056
Mailing Address - Country:US
Mailing Address - Phone:518-435-1123
Mailing Address - Fax:518-435-1506
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1056
Practice Address - Country:US
Practice Address - Phone:518-435-1123
Practice Address - Fax:518-435-1506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000401503014OtherBSNENY
NY11948OtherMVP
NY10006299OtherCDPHP
NY2697144OtherGHI
NY01508465Medicaid
NY11948OtherMVP
NY01508465Medicaid