# ISIDRO M BULATAO MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851516785
- **Authorized official:** ISIDRO M BULATAO MD (PRESIDENT)
- **Authorized official phone:** (518) 235-3990

## Contact information

- **Practice address:** 190 5TH AVE, TROY, NY 12180
- **Practice address phone:** (518) 235-3990
- **Practice address fax:** (518) 235-9177
- **Mailing address:** PO BOX 986, LATHAM, NY 12110
- **Mailing address phone:** (518) 235-3990
- **Mailing address fax:** (518) 235-9177

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | 097438 | NY | Yes |

## Other

- **Enumeration date:** 04/16/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00529300 | — | NY |
| 01 | — | 10000230 | CDPHP | NY |
| 01 | — | 20365 | BLUE CROSS | NY |