Provider Demographics
NPI:1407923873
Name:CAPITAL DISTRICT PEDIATRIC CARDIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:CAPITAL DISTRICT PEDIATRIC CARDIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPOONER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-489-3292
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-489-3292
Mailing Address - Fax:518-453-6286
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-489-3292
Practice Address - Fax:518-453-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00509839Medicaid
NY37990AMedicare UPIN
NY00509839Medicaid