Provider Demographics
NPI:1841584489
Name:EUASHACHAI, MARENA (DO)
Entity Type:Individual
Prefix:DR
First Name:MARENA
Middle Name:
Last Name:EUASHACHAI
Suffix:
Gender:F
Credentials:DO
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:13 PALMER AVE
Practice Address - Street 2:EVERGREEN HEALTH CENTER
Practice Address - City:CORINTH
Practice Address - State:NY
Practice Address - Zip Code:12822-1145
Practice Address - Country:US
Practice Address - Phone:518-654-6499
Practice Address - Fax:518-654-7303
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2022-02-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY271644207Q00000X
A271644171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04060555Medicaid