| For Cdphp Use Only | |
|
112 Charlton Rd Cdphp Site Ballston Lake NY 12019-2547 | |
| (518) 399-7723 | |
| (518) 399-6428 |
| Full Name | For Cdphp Use Only |
|---|---|
| Speciality | Family Medicine |
| Location | 112 Charlton Rd, Ballston Lake, New York |
| Authorized Official Name and Position | Gary Foster (VP/CFO) |
| Authorized Official Contact | 5185838421 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| For Cdphp Use Only Po Box 1220 Albany NY 12201-1220 Ph: (518) 348-1276 | For Cdphp Use Only 112 Charlton Rd Cdphp Site Ballston Lake NY 12019-2547 Ph: (518) 399-7723 |
| NPI Number | 1922482264 |
|---|---|
| Provider Enumeration Date | 07/16/2015 |
| Last Update Date | 07/16/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922482264 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
Burnt Hills Pediatrics & Internal Medicine Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1184 State Route 50, Ballston Lake, NY 12019 Phone: 518-384-1281 Fax: 518-384-0321 |
Scotia Glenville Family Medicine, P.C. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 112 Charlton Rd, Ballston Lake, NY 12019 Phone: 518-399-7723 Fax: 518-399-6428 |