Provider Demographics
NPI:1487895579
Name:WELLS, CATHERINE L (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:L
Last Name:WELLS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:L
Other - Last Name:CLARKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-213-0478
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:711 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 114
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2442
Practice Address - Country:US
Practice Address - Phone:518-786-1600
Practice Address - Fax:518-786-1606
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2650002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03468499Medicaid
NYJ400071149Medicare PIN