Healthcare Provider Details

I. General information

NPI: 1548357866
Provider Name (Legal Business Name): UPSTATE INTERNAL MEDICINE AND PEDIATRICS P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVE SUITE 301
ALBANY NY
12206-1098
US

IV. Provider business mailing address

1365 WASHINGTON AVE SUITE 301
ALBANY NY
12206-1098
US

V. Phone/Fax

Practice location:
  • Phone: 518-458-7212
  • Fax: 518-689-0258
Mailing address:
  • Phone: 518-458-7212
  • Fax: 518-689-0258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number197219
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number197219
License Number StateNY

VIII. Authorized Official

Name: DR. BARBARA ELAINE HAUSER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 518-458-7212