Healthcare Provider Details

I. General information

NPI: 1497751010
Provider Name (Legal Business Name): EDWIN ROBERT WINDLE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/01/2021
Certification Date: 06/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1044 STATE ST
SCHENECTADY NY
12307-1508
US

IV. Provider business mailing address

1044 STATE ST
SCHENECTADY NY
12307-1508
US

V. Phone/Fax

Practice location:
  • Phone: 518-370-1441
  • Fax: 518-395-9431
Mailing address:
  • Phone: 518-370-1441
  • Fax: 518-395-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number194795
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number194795
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number194795
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: