Provider Demographics
NPI:1346463940
Name:NORTH COUNTRY MEDICINE PLLC
Entity Type:Organization
Organization Name:NORTH COUNTRY MEDICINE PLLC
Other - Org Name:NORTH COUNTRY HOLISTIC CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MACDONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-745-5889
Mailing Address - Street 1:461 GLEN ST
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-2906
Mailing Address - Country:US
Mailing Address - Phone:518-745-5889
Mailing Address - Fax:518-745-0010
Practice Address - Street 1:461 GLEN ST
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-2906
Practice Address - Country:US
Practice Address - Phone:518-745-5889
Practice Address - Fax:518-745-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty