GLENN CHAMPAGNE (NPI# 1487869087) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487869087 |
| Entity Type | Individual |
| Full Name | GLENN CHAMPAGNE |
| Credential | M.D. |
| Practice Address |
Bare Hill Road Franklin Correctional Facility Malone NY 12953 |
| Mailing Address |
130 Moody Rd Malone NY 12953-3819 |
| Practice Telephone | 5184836040 |
| Mailing Telephone | 5184831120 |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 127279-1 | NY | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NY | 00632522 | 05 |
| Street Address |
BARE HILL ROAD FRANKLIN CORRECTIONAL FACILITY |
| City | MALONE |
| State | NY |
| Zip Code | 12953 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386264356 | Ruth Ann Williamson | Nurse Practitioner | 31 Sixth St., Malone, NY 12953 | 2020-04-20 |
| 1780203760 | Heather Lynn Lauzon | Peer Specialist | 15 Fouth St, Malone, NY 12953 | 2020-04-10 |
| 1245717115 | Darlean James | Family Medicine | 183 Park St Ste 5678, Malone, NY 12953 | 2018-07-24 |
| 1164929212 | Cheryl Ann Grant | Registered Nurse | 15 Fourth Street, Malone, NY 12953 | 2018-04-06 |
| 1811408826 | Nancy Denis | Registered Nurse | 133 Park Street, Alice Hyde Medical Center, Malone, NY 12953 | 2017-10-17 |
| 1003325424 | Tara Lynn Ellis | Registered Nurse | 23 Husky Lane, Malone, NY 12953 | 2017-09-28 |
| 1578092185 | Shanna Lee Cayea | Peer Specialist | 31 6th Street, Malone, NY 12953 | 2017-06-07 |
| 1184007809 | Alice Hyde Medical Center | Home Health | 45 Sixth St, Malone, NY 12953 | 2015-06-30 |
| 1427303353 | Melissa J Benardot | Nurse Practitioner | 380 Cty Rt 57, Community Health Center, Malone, NY 12953 | 2012-07-17 |
| 1013272202 | Shafiu Oladele Ololade | Internal Medicine | 10 Third Street, Malone, NY 12953 | 2012-07-12 |
| Find all providers in zip 12953 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
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| 1891304325 | Christopher R. Page, M.d., Pllc | General Practice | 46 Route 25a Ste 6, Setauket, NY 11733-2807 | 2020-07-30 |
| 1740804442 | Aliza Hakimian | General Practice | 15 Hill Park Ave Apt 2n, Great Neck, NY 11021-3709 | 2020-05-29 |
| 1962022152 | Lynnette Lallave - Cortes | General Practice | 2 Seaman Ave Apt 1d, New York, NY 10034-2904 | 2020-04-17 |
| 1942829759 | Northeasttelemedicine | General Practice | 483 Coolidge Hill Rd, Diamond Point, NY 12824 | 2020-04-11 |
| 1578198826 | Online Care Medicine PC | General Practice | 26 Oldox Rd, Delmar, NY 12054-2943 | 2020-03-06 |
| 1821621301 | Donnet Andrea Riley | General Practice | 781 Palmer Rd Apt 3a, Bronxville, NY 10708-3309 | 2020-02-12 |
| 1104463652 | Ohad Shimshon Bentur | General Practice | 450 E 63rd St Apt 3g, New York, NY 10065-7957 | 2019-12-03 |
| 1285278291 | Echo Clinical Associates LLC | General Practice | 56 Echo Ave., Ste 1, Miller Place, NY 11764-2454 | 2019-11-01 |
| 1710528583 | Debra Heverly | General Practice | 2315 Whirlpool St # 415, Niagara Falls, NY 14305-2413 | 2019-10-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.