Provider Demographics
NPI:1164864641
Name:CAPITAL REGION PRIMARY CARE PLLC
Entity Type:Organization
Organization Name:CAPITAL REGION PRIMARY CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LIEBERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-243-4134
Mailing Address - Street 1:PO BOX 11226
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-0226
Mailing Address - Country:US
Mailing Address - Phone:518-389-1725
Mailing Address - Fax:518-389-1788
Practice Address - Street 1:2537 ROUTE 9
Practice Address - Street 2:
Practice Address - City:MALTA
Practice Address - State:NY
Practice Address - Zip Code:12020-4328
Practice Address - Country:US
Practice Address - Phone:518-289-2400
Practice Address - Fax:518-289-2410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELLIS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-24
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty