Provider Demographics
NPI:1003826025
Name:KNUDSEN, NANCY S (MD)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:S
Last Name:KNUDSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 GUY PARK AVE
Mailing Address - Street 2:ST MARYS HOSPITAL
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010
Mailing Address - Country:US
Mailing Address - Phone:518-842-1900
Mailing Address - Fax:518-841-7131
Practice Address - Street 1:427 GUY PARK AVE
Practice Address - Street 2:ST MARYS HOSPITAL
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010
Practice Address - Country:US
Practice Address - Phone:518-842-1900
Practice Address - Fax:518-841-7131
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146433-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY146433Medicaid
NYD78441Medicare UPIN
NY146433Medicaid