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391 Myrtle Ave Suite 4d Albany NY 12208-3835 | |
(518) 207-2299 | |
(518) 207-2247 |
Full Name | |
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Speciality | Family Medicine |
Location | 391 Myrtle Ave, Albany, New York |
Authorized Official Name and Position | Diane M Stamas (SENIOR CREDENTIALING COORDINATOR) |
Authorized Official Contact | 5187823742 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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711 Troy Schenectady Rd Suite 203 Latham NY 12110-2442 Ph: (518) 782-3742 | 391 Myrtle Ave Suite 4d Albany NY 12208-3835 Ph: (518) 207-2299 |
NPI Number | 1417300443 |
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Provider Enumeration Date | 07/14/2016 |
Last Update Date | 08/17/2016 |
Identifier | Type | State | Issuer |
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1417300443 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207Q00000X | Family Medicine | 265432 (New York) | Primary |
Memorial Hospital, Albany, N.y. Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 63 Shaker Rd Ste G02, Albany, NY 12204 Phone: 518-449-5352 |