# GLENS FALLS OBSTETRICS & GYNECOLOGY PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275635591
- **Authorized official:** DOUGLAS PROVOST MD (PHYSICIAN)
- **Authorized official phone:** (518) 798-6165

## Contact information

- **Practice address:** 28 S WESTERN AVE, QUEENSBURY, NY 12804-3323
- **Practice address phone:** (518) 798-6165
- **Practice address fax:** (518) 798-0658
- **Mailing address:** 28 SO WESTERN AVENUE, QUEENSBURY, NY 12804
- **Mailing address phone:** (518) 798-6165
- **Mailing address fax:** (518) 798-0658

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | — | NULL | Yes |
| 207V00000X | Obstetrics & Gynecology Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/05/2006
- **Last updated:** 06/02/2015