Provider Demographics
NPI:1326429150
Name:ALBANY MEDICAL COLLEGE
Entity type:Organization
Organization Name:ALBANY MEDICAL COLLEGE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN ALBANY MEDICAL COLLEGE
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-262-6008
Mailing Address - Street 1:PO BOX 416760
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6760
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1365 WASHINGTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-464-1392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-17
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty