Provider Demographics
NPI:1689673378
Name:GIRARD, NANCY A (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:GIRARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2 MARKET ST
Mailing Address - Street 2:POB 129
Mailing Address - City:ALEXANDRIA BAY
Mailing Address - State:NY
Mailing Address - Zip Code:13607-1317
Mailing Address - Country:US
Mailing Address - Phone:315-482-5404
Mailing Address - Fax:315-482-6265
Practice Address - Street 1:2 MARKET ST
Practice Address - Street 2:POB 129
Practice Address - City:ALEXANDRIA BAY
Practice Address - State:NY
Practice Address - Zip Code:13607-1317
Practice Address - Country:US
Practice Address - Phone:315-482-5404
Practice Address - Fax:315-482-6265
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2012-07-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY188587207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01480780Medicaid
NYJ300073782OtherPTAN
NYJ300073782OtherPTAN
NYNYBU14717Medicare PIN