| Canton-potsdam Medical Practice Pllc | |
|
80 East Main Street Canton NY 13617 | |
| (315) 265-3300 | |
| (315) 261-6025 |
| Full Name | Canton-potsdam Medical Practice Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 80 East Main Street, Canton, New York |
| Authorized Official Name and Position | Robert Rogers (AUTHORIZED OFFICIAL) |
| Authorized Official Contact | 3152616013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Canton-potsdam Medical Practice Pllc 50 Leroy St Potsdam NY 13676 Ph: (315) 265-3300 | Canton-potsdam Medical Practice Pllc 80 East Main Street Canton NY 13617 Ph: (315) 265-3300 |
| NPI Number | 1760821417 |
|---|---|
| Provider Enumeration Date | 06/17/2013 |
| Last Update Date | 05/02/2018 |
| Medicare PECOS PAC ID | 6507090883 |
|---|---|
| Medicare Enrollment ID | O20130930000502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760821417 | NPI | - | NPPES |
| J100093911 | Other | NY | PTAN |
| 03652971 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Primary |
| Provider Name | Leo Grafstein |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1093707895 PECOS PAC ID: 5092899211 Enrollment ID: I20100824000923 |
| Provider Name | Jay V Dewell |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1821175563 PECOS PAC ID: 9830370295 Enrollment ID: I20110420000485 |
| Provider Name | Ronald D Weissenberg |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1336249911 PECOS PAC ID: 3870697188 Enrollment ID: I20151117002486 |
| Provider Name | Linda Letham |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700872496 PECOS PAC ID: 5890098370 Enrollment ID: I20160115000667 |
| Provider Name | Mark A Healey |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1477584738 PECOS PAC ID: 6709838824 Enrollment ID: I20160729000771 |
| Provider Name | Gwen Lindsey Bonner |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386901015 PECOS PAC ID: 0042591240 Enrollment ID: I20180913000043 |
| Provider Name | Mallory Sprague |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1366891632 PECOS PAC ID: 0446683312 Enrollment ID: I20191206000869 |
| Provider Name | Jillian Bartling |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1124443841 PECOS PAC ID: 4183031842 Enrollment ID: I20210324001686 |
Canton Health Center Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 39 W Main St, Canton, NY 13617 Phone: 315-379-4700 | |
Canton Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 39 W Main St, Canton, NY 13617 Phone: 315-379-4700 Fax: 315-713-6512 | |
Canton Family Physicians, P.c. Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 80 E Main St, East Wing, Suite 1a, Canton, NY 13617 Phone: 315-386-8184 | |
Healey Medical Practice, Pllc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 25 Park St, Canton, NY 13617 Phone: 315-379-9158 Fax: 315-379-9604 | |
Cerebral Palsy Of The North Country Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 4 Commerce Ln, Canton, NY 13617 Phone: 315-386-1156 Fax: 315-379-9388 | |
St Lawrence County Public Health - Clinic Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 80 State Highway 310 Ste 2, Canton, NY 13617 Phone: 315-386-2325 Fax: 315-386-2203 |