| Fulton Family Medicine Practice Pc | |
|
20 Canalview Mall Fulton NY 13069-1735 | |
| (315) 532-8049 | |
| Not Available |
| Full Name | Fulton Family Medicine Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 20 Canalview Mall, Fulton, New York |
| Authorized Official Name and Position | Esther Serwadda Lubinga (OWNER) |
| Authorized Official Contact | 3155328049 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Fulton Family Medicine Practice Pc 1782 State Route 48 Fulton NY 13069-4108 Ph: (315) 532-8049 | Fulton Family Medicine Practice Pc 20 Canalview Mall Fulton NY 13069-1735 Ph: (315) 532-8049 |
| NPI Number | 1275806036 |
|---|---|
| Provider Enumeration Date | 02/09/2012 |
| Last Update Date | 05/01/2013 |
| Medicare PECOS PAC ID | 4385806587 |
|---|---|
| Medicare Enrollment ID | O20120504000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275806036 | NPI | - | NPPES |
| 03444819 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2618481 (New York) | Primary |
| Provider Name | Christine K Atkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861426215 PECOS PAC ID: 2466460803 Enrollment ID: I20060403000244 |
| Provider Name | Esther N Lubinga |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760658512 PECOS PAC ID: 1658565072 Enrollment ID: I20120504000423 |
| Provider Name | Rebecca L Dottolo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053672261 PECOS PAC ID: 7315197605 Enrollment ID: I20121023000147 |
| Provider Name | Denise M Carter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952662645 PECOS PAC ID: 8628220589 Enrollment ID: I20121129000209 |
| Provider Name | Kirsten L Manganiello |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104259050 PECOS PAC ID: 2365677614 Enrollment ID: I20131023000613 |
| Provider Name | Panita Pipatnawin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033604970 PECOS PAC ID: 9638413867 Enrollment ID: I20181129000516 |
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