Provider Demographics
NPI:1134127335
Name:KERCULL, ROBERT GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:KERCULL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-1009
Mailing Address - Country:US
Mailing Address - Phone:518-587-8887
Mailing Address - Fax:518-583-9294
Practice Address - Street 1:195 CHURCH ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-1009
Practice Address - Country:US
Practice Address - Phone:518-587-8887
Practice Address - Fax:518-583-9294
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097868207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY201002419OtherPALMETTO/GBA/RR MEDICARE
NY00525228Medicaid
NY00525228Medicaid