Healthcare Provider Details

I. General information

NPI: 1528327582
Provider Name (Legal Business Name): WILLIAM DAVENPORT ULMER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE DEPARTMENT OF UROLOGY
ALBANY NY
12208-3412
US

IV. Provider business mailing address

47 NEW SCOTLAND AVE DEPARTMENT OF UROLOGY
ALBANY NY
12208-3412
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-3095
  • Fax:
Mailing address:
  • Phone: 518-262-3095
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number63267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: