Mountain Medical Pediatrics

Primary specialty

SpecialistTaxonomy code 174400000X

License

236345 Issued in NY

Legal business name

MOUNTAIN MEDICAL PEDIATRICS

Practice address

1927 Saranac Ave
Saranac Lake, NY 12983

Phone

(518) 523-7575

NPI assigned

May 3, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Keri Wallace

Title

M.D.

Phone

(518) 523-7575

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael PM Pond, MD

  • Emergency Medicine Physician
  • Lake Placid, NY
  • NPI 1962472514
  NPD
• Dorit Dorcas Gaedtke, MD

  • Internal Medicine Physician
  • Lake Placid, NY
  • NPI 1740254069
  NPD (past)
• Dona Kilgore, DONA KILGORE, RPA-C

  • Physician Assistant
  • Tupper Lake, NY
  • NPI 1588976484
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203292800000",
    "number": "1821210352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1927 SARANAC AVE",
            "city": "SARANAC LAKE",
            "state": "NY",
            "postal_code": "12983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1927 SARANAC AVE",
            "city": "SARANAC LAKE",
            "state": "NY",
            "postal_code": "12983",
            "telephone_number": "518-523-7575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN MEDICAL PEDIATRICS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-03",
        "last_updated": "2008-02-18",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "KERI",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "518-523-7575",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": "NY",
            "license": "236345",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02752954",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas F Minehan, MD
• Erin Elizabeth Mitchell
• Richard Michael Moccia, MD
• Emily Beatty Monaco, PA-C
• Patricia Kathryn Monroe, MD
• Mountain Medical Services
• John Douglass Murray, DDS
• Taylor Lin Nedurian, PA
• Roger William Neill, DMD
• Carol Nevulis, PAC

• Specialist in Saranac Lake, NY
• Providers in Saranac Lake, NY by specialty
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.