| Organization Name: | NORTH COUNTRY MEDICINE PLLC |
| NPI Number: | 1346463940 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DIANE MARIE MACDONNELL (PROPRIETOR) |
| Mailing Address: | 461 Glen St Glens Falls |
| State: | NY US |
| Postal Code: | 128012906 |
| Phone Number: | 5187455889 |
| Fax Number: | 5187450010 |
| NPI Enumeration Date: | 04/11/2007 |
| NPI Last Update Date: | 08/21/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |