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General NPI Number Information
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NPI Number | 1154310266
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Entity Type | Individual
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Provider Name | ALBERT PERSIA M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/20/2005
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Last Update Date | 04/14/2014
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Provider Practice Location Address
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Address Line | 42 DUNHAM AVE
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City | JAMESTOWN
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State | NY
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Zip | 14701-2514
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Country | US
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Telephone | 716-665-7007
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Fax | 716-664-6131
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Provider Business Mailing Address
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Address Line | 95 EAST CHAUTAUQUA ST PO BOX 168
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City | MAYVILLE
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State | NY
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Zip | 14757-0168
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Country | US
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Telephone | 716-753-7107
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Fax | 716-753-5367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 210053
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License Number State | NY
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