Healthcare Provider Details

I. General information

NPI: 1619946258
Provider Name (Legal Business Name): DURDANA MEHTABDIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2022 WESTERN AVE GUILDERLAND FAMILY PRACTICE
ALBANY NY
12203
US

IV. Provider business mailing address

2022 WESTERN AVE GUILDERLAND FAMILY PRACTICE
ALBANY NY
12203
US

V. Phone/Fax

Practice location:
  • Phone: 518-464-9000
  • Fax: 518-464-9200
Mailing address:
  • Phone: 518-464-9000
  • Fax: 518-464-9200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number168137
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: