Provider Demographics
NPI:1235380809
Name:PEDIATRIC ASSOCIATES OF TROY PLLC
Entity Type:Organization
Organization Name:PEDIATRIC ASSOCIATES OF TROY PLLC
Other - Org Name:BELLO AND MALONE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEETHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GURRALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-0232
Mailing Address - Street 1:2001 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3340
Mailing Address - Country:US
Mailing Address - Phone:518-272-0232
Mailing Address - Fax:518-272-4083
Practice Address - Street 1:2001 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3340
Practice Address - Country:US
Practice Address - Phone:518-272-0232
Practice Address - Fax:518-272-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227601261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00994918Medicaid