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General NPI Number Information
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NPI Number | 1720055098
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Entity Type | Individual
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Provider Name | BORIS MEDAROV MD
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Gender | Male
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Dates
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Enumeration Date | 03/04/2006
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 47 NEW SCOTLAND AVE # A-91
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City | ALBANY
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State | NY
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Zip | 12208-3412
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Country | US
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Telephone | 518-262-5196
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Fax |
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Provider Business Mailing Address
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Address Line | 47 NEW SCOTLAND AVE # A-91
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City | ALBANY
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State | NY
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Zip | 12208-3412
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Country | US
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Telephone | 518-262-5196
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Fax |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 042836
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 042836
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A105076
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A105076
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License Number State | CA
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