Provider Demographics
NPI:1770673311
Name:SAUNDERS, PATRICIA
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1792
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-0119
Mailing Address - Country:US
Mailing Address - Phone:518-250-4325
Mailing Address - Fax:518-250-4326
Practice Address - Street 1:523 WESTERN AVE 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1617
Practice Address - Country:US
Practice Address - Phone:518-250-4325
Practice Address - Fax:518-250-4326
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193468207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02596101Medicaid
NY02596101Medicaid
NYRA4773Medicare PIN
NYRB5980Medicare PIN