Provider Demographics
NPI:1245329622
Name:STAM, KATHERINE L (DO)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:L
Last Name:STAM
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:713 TROY SCHENECTADY RD
Practice Address - Street 2:SUITE 215
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2490
Practice Address - Country:US
Practice Address - Phone:518-713-5347
Practice Address - Fax:518-713-5359
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-03-14
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Provider Licenses
StateLicense IDTaxonomies
NY211086207Q00000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY08885OtherMVP
NY01871636Medicaid
NY070820000064OtherFIDELIS
NY000490182005OtherBSNENY
NY5551692OtherAETNA
NY201082OtherSENIOR WHOLE HEALTH
NY10027960OtherCDPHP
NY119580OtherGHI/HMO
NY6D0821OtherEMPIRE BC
NYRB4264-RB4265Medicare PIN
NY000490182005OtherBSNENY
NY10027960OtherCDPHP