MEDICARE: ROBERT NIELSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	147659	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2P77010	OTHER	NY	EMPIRE BLUE CROSS
2	040426007158	OTHER	NY	FIDELIS
3	47104	OTHER	NY	GHI HMO
4	77856137	OTHER	NY	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	10023164	OTHER	NY	CDPHP
7	000401351002	OTHER	NY	BLUE SHIELD
8	08563	OTHER	NY	MVP

General Provider Information

NPI Number	:	1073580627
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT NIELSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 1368
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12201-1368
Country	:	US
Telephone Number	:	518-886-5800
Fax Number	:	518-886-5805

Provider Business Practice Location Address
First Line	:	3044 ROUTE 50
Second Line	:
City	:	SARATOGA SPRINGS
State	:	NY
Zip	:	12866-2906
Country	:	US
Telephone Number	:	518-886-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2006
Last Update Date	:	10/12/2015

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