Provider Demographics
NPI:1780994111
Name:COLUMBIA INTERNAL MEDICINE
Entity type:Organization
Organization Name:COLUMBIA INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:
Authorized Official - Last Name:SRIPADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-391-2889
Mailing Address - Street 1:2500 POND VW STE 202
Mailing Address - Street 2:
Mailing Address - City:CASTLETON
Mailing Address - State:NY
Mailing Address - Zip Code:12033-9776
Mailing Address - Country:US
Mailing Address - Phone:518-391-2889
Mailing Address - Fax:518-391-2304
Practice Address - Street 1:2500 POND VW STE 202
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9776
Practice Address - Country:US
Practice Address - Phone:518-391-2889
Practice Address - Fax:518-391-2304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS219899261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0888Medicare PIN