MEDICARE: DR. RON KEVIN WOLNER M.D

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	2084P0800X	Psychiatry Physician	150789	NY

General Provider Information

NPI Number	:	1730112897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RON KEVIN WOLNER M.D

Provider Business Mailing Address
First Line	:	2 TOWER PL
Second Line	:	EXECUTIVE PARK
City	:	ALBANY
State	:	NY
Zip	:	12203-3735
Country	:	US
Telephone Number	:	518-482-3169
Fax Number	:	518-446-9979

Provider Business Practice Location Address
First Line	:	2 TOWER PL
Second Line	:	EXECUTIVE PARK
City	:	ALBANY
State	:	NY
Zip	:	12203-3735
Country	:	US
Telephone Number	:	518-482-3169
Fax Number	:	518-446-9979

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

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	09/06/2023

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