Healthcare Provider Details

I. General information

NPI: 1659370583
Provider Name (Legal Business Name): JAMES BARADA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 WASHINGTON AVE SUITE 102
ALBANY NY
12206-1098
US

IV. Provider business mailing address

PO BOX 8701
ALBANY NY
12208-0701
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-9838
  • Fax: 518-446-0995
Mailing address:
  • Phone: 518-446-9838
  • Fax: 518-446-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number172973
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: