Provider Demographics
NPI:1811963937
Name:SGAMBATI, CARL W (MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:W
Last Name:SGAMBATI
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1368
Mailing Address - Country:US
Mailing Address - Phone:518-886-5112
Mailing Address - Fax:518-693-4490
Practice Address - Street 1:3050 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2906
Practice Address - Country:US
Practice Address - Phone:518-886-5112
Practice Address - Fax:518-693-4490
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02737355Medicaid
NY02737355Medicaid
NYJ400016945Medicare PIN
NYRB0069Medicare PIN