Provider Demographics
NPI:1750310645
Name:PROVIDENT EMERGENCY MEDICINE ASSOCIATES, PC
Entity Type:Organization
Organization Name:PROVIDENT EMERGENCY MEDICINE ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:A
Authorized Official - Last Name:BARROWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-383-5450
Mailing Address - Street 1:PO BOX 1597
Mailing Address - Street 2:428 CLIFTON CORPORATE PARK
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-0807
Mailing Address - Country:US
Mailing Address - Phone:518-383-5450
Mailing Address - Fax:518-383-4223
Practice Address - Street 1:600 MCCLELLAN ST
Practice Address - Street 2:@ ST. CLARE'S HOSPITAL ER DEPT
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-1009
Practice Address - Country:US
Practice Address - Phone:518-383-5450
Practice Address - Fax:518-383-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0050Medicare PIN