Provider Demographics
NPI:1912967241
Name:RIVARD, DONALD JOSEPH (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:JOSEPH
Last Name:RIVARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:
Practice Address - Street 1:25 HACKETT BLVD
Practice Address - Street 2:DIVISION OF UROLOGY (MC 208)
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3420
Practice Address - Country:US
Practice Address - Phone:518-262-3341
Practice Address - Fax:518-262-6660
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY121265208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00371435Medicaid
NY00371435Medicaid
NYB82183Medicare UPIN
NYRB2564Medicare PIN