Provider Demographics
NPI:1407956519
Name:COMMUNITY CARE PHYSICIANS, PC
Entity Type:Organization
Organization Name:COMMUNITY CARE PHYSICIANS, PC
Other - Org Name:CAPITAL DISTRICT OB/GYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR CREDENTIALING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:STAMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-782-3742
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:5 ELM AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-3702
Practice Address - Country:US
Practice Address - Phone:518-439-9363
Practice Address - Fax:518-439-4018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2013-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184827207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01450619Medicaid
NYCC5862Medicare ID - Type Unspecified
NYF59501Medicare UPIN
NYAA0852Medicare PIN