Provider Demographics
NPI:1891841516
Name:BETTIGOLE, R ELLEN (MD)
Entity Type:Individual
Prefix:
First Name:R
Middle Name:ELLEN
Last Name:BETTIGOLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3410
Mailing Address - Country:US
Mailing Address - Phone:518-270-2800
Mailing Address - Fax:518-270-2723
Practice Address - Street 1:1600 7TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3410
Practice Address - Country:US
Practice Address - Phone:518-270-2800
Practice Address - Fax:518-270-2723
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198099-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY198099-01OtherSTATE OF NEW YORK LICENSE