Healthcare Provider Details

I. General information

NPI: 1225372436
Provider Name (Legal Business Name): ALBANY MEDICAL COLLEGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 WASHINGTON AVENUE EXT STE 102
ALBANY NY
12203-5300
US

IV. Provider business mailing address

PO BOX 416760
BOSTON MA
02241-6760
US

V. Phone/Fax

Practice location:
  • Phone: 518-264-2510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT VERDILE
Title or Position: DEAN ALBANY MEDICAL COLLEGE
Credential: MD
Phone: 518-262-6008