Provider Demographics
NPI:1861939944
Name:CARONDELET REGIONAL MEDICAL, PC
Entity type:Organization
Organization Name:CARONDELET REGIONAL MEDICAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:427 GUY PARK AVE
Mailing Address - Street 2:
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-1064
Mailing Address - Country:US
Mailing Address - Phone:518-841-7401
Mailing Address - Fax:518-841-7404
Practice Address - Street 1:3768 STATE HIGHWAY 30
Practice Address - Street 2:BROADALBIN HEALTH CENTER
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty