Provider Demographics
NPI:1487706917
Name:SUNY POTSDAM
Entity type:Organization
Organization Name:SUNY POTSDAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR STUDENT HEALTH
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:BARTLETT
Authorized Official - Last Name:DOELGER
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:315-267-2377
Mailing Address - Street 1:44 PIERREPONT AVE
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-2200
Mailing Address - Country:US
Mailing Address - Phone:315-267-2377
Mailing Address - Fax:315-267-3260
Practice Address - Street 1:44 PIERREPONT AVE
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-2200
Practice Address - Country:US
Practice Address - Phone:315-267-2377
Practice Address - Fax:315-267-3260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF301604261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health