Healthcare Provider Details

I. General information

NPI: 1053316042
Provider Name (Legal Business Name): GIRIDHAR CHOLPADY KAMATH D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 EVERETT RD EXT
ALBANY NY
12205-3357
US

IV. Provider business mailing address

21 EVERETT RD EXT
ALBANY NY
12205-3357
US

V. Phone/Fax

Practice location:
  • Phone: 518-867-8080
  • Fax: 518-867-8088
Mailing address:
  • Phone: 518-867-8080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number230087
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS011858
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1884
License Number StateME
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number056306
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: