Provider Demographics
NPI:1932281524
Name:CAPITAL DISTRICT DERMATOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:CAPITAL DISTRICT DERMATOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:C
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-455-8708
Mailing Address - Street 1:149 S LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3201
Mailing Address - Country:US
Mailing Address - Phone:518-434-8121
Mailing Address - Fax:518-426-0620
Practice Address - Street 1:149 S LAKE AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3201
Practice Address - Country:US
Practice Address - Phone:518-434-8121
Practice Address - Fax:518-426-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCF7151OtherRAILROAD MEDICARE
NY37925AMedicare PIN