Provider Demographics
NPI:1376586735
Name:GARCIA, JUAN CARLOS (MD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:GARCIA
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 1:102 PARK ST
Mailing Address - Street 2:SUITE 202, PO BOX 787
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4449
Mailing Address - Country:US
Mailing Address - Phone:518-793-0475
Mailing Address - Fax:518-793-6658
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:SUITE 202
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4449
Practice Address - Country:US
Practice Address - Phone:518-793-0475
Practice Address - Fax:518-793-6658
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02191151Medicaid
RA5939Medicare ID - Type Unspecified
NY02191151Medicaid