# LAKE CHAMPLAIN OB/GYN, PC

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

## Provider details

- **NPI number:** 1891708095
- **Authorized official:** JEANNIE S VAN NOSTRAND (OFFICE MANAGER)
- **Authorized official phone:** (518) 566-9452

## Contact information

- **Practice address:** 206 CORNELIA ST, SUITE 306, PLATTSBURGH, NY 12901-2779
- **Practice address phone:** (518) 566-9452
- **Practice address fax:** (519) 562-7189
- **Mailing address:** 206 CORNELIA ST, SUITE 306, PLATTSBURGH, NY 12901-2779
- **Mailing address phone:** (518) 566-9452
- **Mailing address fax:** (519) 562-7189

## Taxonomy

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

## Other

- **Enumeration date:** 08/15/2006
- **Last updated:** 11/03/2014