Provider Demographics
NPI:1831398965
Name:CANTON POTSDAM HOSPITAL
Entity type:Organization
Organization Name:CANTON POTSDAM HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEWAR
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:315-386-8184
Mailing Address - Street 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-261-5969
Mailing Address - Fax:
Practice Address - Street 1:6810 THOROLD STONE ROAD
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:ONTARIO
Practice Address - Zip Code:L2J 1B4
Practice Address - Country:CA
Practice Address - Phone:905-354-6443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011571284300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes284300000XHospitalsSpecial Hospital