Provider Demographics
NPI:1932191079
Name:ROLAND, CLAUDE R (MD)
Entity Type:Individual
Prefix:
First Name:CLAUDE
Middle Name:R
Last Name:ROLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 CORNELIA STREET
Mailing Address - Street 2:SUITE 104
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-0000
Mailing Address - Country:US
Mailing Address - Phone:518-562-7557
Mailing Address - Fax:518-562-7559
Practice Address - Street 1:206 CORNELIA ST
Practice Address - Street 2:SUITE 104
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2779
Practice Address - Country:US
Practice Address - Phone:518-562-7557
Practice Address - Fax:518-562-7559
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY203101-12086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01972430Medicaid
BB6320Medicare ID - Type Unspecified
NY01972430Medicaid