Organization
CANTON-POTSDAM MEDICAL PRACTICE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHLEY PEGGS (PROVIDER ENROLLMENT MANAGER)
(315) 261-5044
Entity
Organization
Contact information
Practice address
80 EAST MAIN STREET, CANTON, NY 13617
(315) 265-3300
(315) 261-6025
Mailing address
50 LEROY ST, POTSDAM, NY 13676
(315) 265-3300
(315) 261-6025
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03652971
—
NY
01
—
J100093911
PTAN
NY
Enumeration date
06/17/2013
Last updated
11/13/2024
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