Provider Demographics
NPI:1699867333
Name:BALDWINSVILLE MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:BALDWINSVILLE MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAUSHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:NANAVATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:315-635-5700
Mailing Address - Street 1:3070 BELGIUM RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9239
Mailing Address - Country:US
Mailing Address - Phone:315-635-5700
Mailing Address - Fax:315-635-5313
Practice Address - Street 1:3070 BELGIUM RD
Practice Address - Street 2:
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-9239
Practice Address - Country:US
Practice Address - Phone:315-635-5700
Practice Address - Fax:315-635-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0148Medicare ID - Type Unspecified