Provider Demographics
NPI:1285605857
Name:ALBERT, KEVIN C (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:C
Last Name:ALBERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:105 BUNKER HILL RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12185-1916
Mailing Address - Country:US
Mailing Address - Phone:518-753-7697
Mailing Address - Fax:
Practice Address - Street 1:258 HOOSICK ST STE 106
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2446
Practice Address - Country:US
Practice Address - Phone:518-273-3732
Practice Address - Fax:518-272-2993
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2039432080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01720456Medicaid
NY10002411OtherCDPHP