Organization
NORTH COUNTRY SPORTS MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LORI BALDWIN (PRACTICE ADMINISTRATOR)
(518) 793-9156
Entity
Organization
Contact information
Practice address
79 NORTH ST, GRANVILLE, NY 12832-1137
(518) 793-9156
(518) 793-6591
Mailing address
25 WILLOWBROOK RD, SUITE 2, QUEENSBURY, NY 12804-5882
(518) 793-9156
(518) 793-6591
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
189371
NY
Other
Enumeration date
06/29/2012
Last updated
06/29/2012
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