Individual
DR. JUSTIN A. PROVOST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
848 ROUTE 50, BURNT HILLS, NY 12027
(518) 831-1500
(518) 280-8464
Mailing address
848 ROUTE 50, BURNT HILLS, NY 12027-9511
(518) 831-1500
(518) 280-8464
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
GME PERMIT
CT
207R00000X
Internal Medicine Physician
R2077
KY
207RG0100X
Gastroenterology Physician
Primary
278649
NY
Other
Enumeration date
04/03/2009
Last updated
02/12/2024
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