Healthcare Provider Details

I. General information

NPI: 1356593883
Provider Name (Legal Business Name): RADMILA LYUBAROVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2008
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 NEW SCOTLAND AVE MC 44
ALBANY NY
12208-3412
US

IV. Provider business mailing address

196 BLESSING RD APT 76
SLINGERLANDS NY
12159-2105
US

V. Phone/Fax

Practice location:
  • Phone: 518-262-5078
  • Fax:
Mailing address:
  • Phone: 518-512-3870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number253982
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number253982
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: