Provider Demographics
NPI:1972296630
Name:CARONDELET REGIONAL MEDICAL, PC
Entity type:Organization
Organization Name:CARONDELET REGIONAL MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-843-6914
Mailing Address - Street 1:3768 STATE HIGHWAY 30
Mailing Address - Street 2:
Mailing Address - City:BROADALBIN
Mailing Address - State:NY
Mailing Address - Zip Code:12025-0923
Mailing Address - Country:US
Mailing Address - Phone:518-883-3121
Mailing Address - Fax:518-883-8268
Practice Address - Street 1:3768 STATE HIGHWAY 30
Practice Address - Street 2:
Practice Address - City:BROADALBIN
Practice Address - State:NY
Practice Address - Zip Code:12025-0923
Practice Address - Country:US
Practice Address - Phone:518-883-3121
Practice Address - Fax:518-883-8268
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARONDELET REGIONAL MEDICAL, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty