Provider Demographics
NPI:1770528473
Name:CONVENIENT MEDICAL CARE, PC
Entity type:Organization
Organization Name:CONVENIENT MEDICAL CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:REYNOLDS
Authorized Official - Last Name:MERRIHEW
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:518-792-2181
Mailing Address - Street 1:319 BAY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-1402
Mailing Address - Country:US
Mailing Address - Phone:518-792-2181
Mailing Address - Fax:518-792-1531
Practice Address - Street 1:319 BAY RD
Practice Address - Street 2:
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-1402
Practice Address - Country:US
Practice Address - Phone:518-792-2181
Practice Address - Fax:518-792-1531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY148341-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB80322Medicare UPIN
NY50041AMedicare PIN