Provider Demographics
NPI:1316905284
Name:PRATT, STEPHEN R (MD)
Entity type:Individual
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First Name:STEPHEN
Middle Name:R
Last Name:PRATT
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1004 VALERIE DR
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1630
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:ST. PETER'S HOSPITAL
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-6560
Practice Address - Fax:518-525-6555
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2021-06-09
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Provider Licenses
StateLicense IDTaxonomies
NY1858502080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01833316Medicaid