Healthcare Provider Details

I. General information

NPI: 1316905284
Provider Name (Legal Business Name): STEPHEN R PRATT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 S MANNING BLVD ST. PETER'S HOSPITAL
ALBANY NY
12208-1707
US

IV. Provider business mailing address

1004 VALERIE DR
NISKAYUNA NY
12309-1630
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-6560
  • Fax: 518-525-6555
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number185850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: