Provider Demographics
NPI:1043891096
Name:SARATOGA REGIONAL MEDICAL , P.C
Entity Type:Organization
Organization Name:SARATOGA REGIONAL MEDICAL , P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STAHURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-583-8346
Mailing Address - Street 1:PO BOX 412655
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2655
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 MAPLE DELL STE 1
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2953
Practice Address - Country:US
Practice Address - Phone:518-886-5112
Practice Address - Fax:518-886-5880
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SARATOGA REGIONAL MEDICAL , P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care