Provider Demographics
NPI:1275775298
Name:NORTH COUNTRY THORACIC & VASCULAR, PC
Entity Type:Organization
Organization Name:NORTH COUNTRY THORACIC & VASCULAR, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:NACHBAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-314-1520
Mailing Address - Street 1:12 HEALEY AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2413
Mailing Address - Country:US
Mailing Address - Phone:518-314-1520
Mailing Address - Fax:518-563-6413
Practice Address - Street 1:12 HEALEY AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2413
Practice Address - Country:US
Practice Address - Phone:518-314-1520
Practice Address - Fax:518-563-6413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY240212-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty