Provider Demographics
NPI:1942255930
Name:CAPITAL UROLOGY CARE, P.C.
Entity Type:Organization
Organization Name:CAPITAL UROLOGY CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:RIVARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-598-0778
Mailing Address - Street 1:205 N PEARL ST
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12207-2309
Mailing Address - Country:US
Mailing Address - Phone:518-598-0778
Mailing Address - Fax:518-489-6471
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-489-6468
Practice Address - Fax:518-489-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121265208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0580Medicare ID - Type UnspecifiedGROUP MEDICARE #