Provider Demographics
NPI:1851353882
Name:FIVE CORNERS FAMILY PRACTICE PC
Entity Type:Organization
Organization Name:FIVE CORNERS FAMILY PRACTICE PC
Other - Org Name:FIVE CORNERS FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-357-2011
Mailing Address - Street 1:3040 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12306-2102
Mailing Address - Country:US
Mailing Address - Phone:518-357-2011
Mailing Address - Fax:518-357-2330
Practice Address - Street 1:3040 BROADWAY
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12306-2102
Practice Address - Country:US
Practice Address - Phone:518-357-2011
Practice Address - Fax:518-357-2330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty