Healthcare Provider Details

I. General information

NPI: 1659900413
Provider Name (Legal Business Name): ALEXANDER SAMUEL FORD DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 09/22/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 WASHINGTON AVE EXT PINE WEST PLZ BLDG 3 STE 305
ALBANY NY
12205-5558
US

IV. Provider business mailing address

305 WASHINGTON AVE EXT PINE WEST PLZ BLDG 3 STE 305
ALBANY NY
12205-5558
US

V. Phone/Fax

Practice location:
  • Phone: 518-749-4679
  • Fax: 518-401-9109
Mailing address:
  • Phone: 518-749-4679
  • Fax: 518-401-9109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number323465-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: