MEDICARE: DR. ANN KIELER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	129820	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10001057	OTHER		CDPHP
2	78E16	OTHER		BCBS

General Provider Information

NPI Number	:	1295760577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANN KIELER MD

Provider Business Mailing Address
First Line	:	30 HASWELL GREENE RD
Second Line	:
City	:	DELMAR
State	:	NY
Zip	:	12054-9777
Country	:	US
Telephone Number	:	518-465-7172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1375 WASHINGTON AVE
Second Line	:	SUITE 227
City	:	ALBANY
State	:	NY
Zip	:	12206-1070
Country	:	US
Telephone Number	:	518-465-7172
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	01/30/2013

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