Individual
DR. BORIS MEDAROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
47 NEW SCOTLAND AVE # A-91, ALBANY, NY 12208-3412
(518) 262-5196
Mailing address
47 NEW SCOTLAND AVE # A-91, ALBANY, NY 12208-3412
(518) 262-5196
Taxonomy
Speciality
Code
Description
License number
State
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
042836
CT
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
A105076
CA
207RP1001X
Pulmonary Disease Physician
042836
CT
207RP1001X
Pulmonary Disease Physician
Primary
A105076
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1356390009
GROUP NPI
CA
01
—
1902846306
GROUP NPI
CA
01
—
CE1617
GROUP RAILROAD MEDICARE
CA
01
—
GR0100430
GROUP MEDICAL
CA
01
—
GROO16910
GROUP MEDICAID PIN
CA
01
—
W11675
MEDICARE GROUP PIN
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
03/04/2006
Last updated
11/17/2015
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