Provider Demographics
NPI:1407809981
Name:CHAMPLAIN VALLEY CARDIOLOGY, PC
Entity Type:Organization
Organization Name:CHAMPLAIN VALLEY CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GARRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-562-7990
Mailing Address - Street 1:210 CORNELIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2318
Mailing Address - Country:US
Mailing Address - Phone:518-562-7990
Mailing Address - Fax:
Practice Address - Street 1:210 CORNELIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2318
Practice Address - Country:US
Practice Address - Phone:518-562-7990
Practice Address - Fax:518-562-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0419Medicare PIN
NYDD2666Medicare PIN