Provider Demographics
NPI:1902914526
Name:CAPITAL DISTRICT SURGICAL ASSOCIATES, P.L.L.C.
Entity Type:Organization
Organization Name:CAPITAL DISTRICT SURGICAL ASSOCIATES, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:GEBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-0171
Mailing Address - Street 1:2231 BURDETT AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2447
Mailing Address - Country:US
Mailing Address - Phone:518-272-0171
Mailing Address - Fax:518-271-6580
Practice Address - Street 1:2231 BURDETT AVE
Practice Address - Street 2:SUITE 130
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2447
Practice Address - Country:US
Practice Address - Phone:518-272-0171
Practice Address - Fax:518-271-6580
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01752712Medicaid
56701AMedicare ID - Type Unspecified