Individual
GLENN CHAMPAGNE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
BARE HILL ROAD, FRANKLIN CORRECTIONAL FACILITY, MALONE, NY 12953
(518) 483-6040
Mailing address
130 MOODY RD, MALONE, NY 12953-3819
(518) 483-1120
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
127279-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00632522
—
NY
Enumeration date
05/14/2007
Last updated
07/08/2007
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