1528069010 NPI number — MR. PAUL D DAMICO CRNA

Table of content: MR. PAUL D DAMICO CRNA (NPI 1528069010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528069010 NPI number — MR. PAUL D DAMICO CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAMICO
Provider First Name:
PAUL
Provider Middle Name:
D
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528069010
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1201 NOTT ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12308-2589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-3123
Provider Business Mailing Address Fax Number:
518-374-9711

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 NOTT ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SCHENECTADY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12308-2589
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-374-3123
Provider Business Practice Location Address Fax Number:
518-374-9711
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  469255-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9704569 . This is a "GHI" identifier . This identifiers is of the category "OTHER".
  • Identifier: BB6650 . This is a "FIDELIS MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000496079001 . This is a "BLUE SHIELD NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: R6B52 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: X00000 . This is a "AMERICAN PROGRESSIVE TODA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10002421 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 469255-1 . This is a "TRICARE NORTH REGION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4123058 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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