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Organization
MOUNTAIN MEDICAL PEDIATRICS
Active
Organization
MOUNTAIN MEDICAL PEDIATRICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KERI WALLACE (M.D.)
(518) 523-7575
Entity
Organization
Contact information
Practice address
1927 SARANAC AVE, SARANAC LAKE, NY 12983
(518) 523-7575
Mailing address
1927 SARANAC AVE, SARANAC LAKE, NY 12983
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
236345
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02752954
—
NY
Enumeration date
05/03/2007
Last updated
02/18/2008
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