Provider Demographics
NPI:1649276122
Name:SCHIMELMAN, MARK ALLAN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:SCHIMELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 N GREENBUSH RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8369
Mailing Address - Country:US
Mailing Address - Phone:518-286-3000
Mailing Address - Fax:518-286-3008
Practice Address - Street 1:76 N GREENBUSH RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8369
Practice Address - Country:US
Practice Address - Phone:518-286-3000
Practice Address - Fax:518-286-3008
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149089208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY149089OtherLICENSE
NY5055BMedicare ID - Type Unspecified
NY149089OtherLICENSE