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NPI Code Detail

MEDICARE: KYLE BRAHIM ANGELICOLA-RICHARDSON MD

MEDICARE: KYLE BRAHIM ANGELICOLA-RICHARDSON 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
1207XS0106XOrthopaedic Hand Surgery Physician318975NY
2207X00000XOrthopaedic Surgery Physician318975NY

General Provider Information

NPI Number : 1346771631
Entity Type Code : Individual
Provider Name (Legal Business Name) : KYLE BRAHIM ANGELICOLA-RICHARDSON MD
Provider Business Mailing Address
First Line : PO BOX 14890
Second Line :
City : ALBANY
State : NY
Zip : 12212-4890
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1182 TROY SCHENECTADY RD STE 100
Second Line :
City : LATHAM
State : NY
Zip : 12110-1000
Country : US
Telephone Number : 518-269-4690
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2017
Last Update Date : 03/02/2026

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