Provider Demographics
NPI:1902816473
Name:MARC D PRICE DO PLLC
Entity type:Organization
Organization Name:MARC D PRICE DO PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARC
Authorized Official - Middle Name:D
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:518-899-5390
Mailing Address - Street 1:2388 ROUTE 9
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MECHANCVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12118
Mailing Address - Country:US
Mailing Address - Phone:518-899-5390
Mailing Address - Fax:518-899-5343
Practice Address - Street 1:2388 ROUTE 9
Practice Address - Street 2:SUITE 200
Practice Address - City:MECHANCVILLE
Practice Address - State:NY
Practice Address - Zip Code:12118
Practice Address - Country:US
Practice Address - Phone:518-899-5390
Practice Address - Fax:518-899-5343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219996207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02312641Medicaid
NY02312641Medicaid
H68920Medicare UPIN
NYRA8842Medicare ID - Type UnspecifiedINDIVIDUAL