Organization
ST LAWRENCE RADIOLOGY ASSOC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GLAUCO MARESCA MD (PRESIDENT/CEO)
(315) 265-4924
Entity
Organization
Contact information
Practice address
50 LEROY ST, CANTON POTSDAM HOSPITAL, POTSDAM, NY 13676-1786
(315) 782-2620
(315) 788-4980
Mailing address
PO BOX 41643, BALTIMORE, MD 21203-6643
(443) 274-2888
(443) 274-2391
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01350563
—
NY
Enumeration date
03/21/2006
Last updated
06/01/2020
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