Provider Demographics
NPI:1699777136
Name:CLEVELAND, BYRD (MD)
Entity type:Individual
Prefix:DR
First Name:BYRD
Middle Name:
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:ELIZABETH
Other - Last Name:CLEVELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 HACKETT BLVD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1750
Mailing Address - Country:US
Mailing Address - Phone:518-262-4439
Mailing Address - Fax:518-262-8460
Practice Address - Street 1:66 HACKETT BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1750
Practice Address - Country:US
Practice Address - Phone:518-262-4439
Practice Address - Fax:518-262-8460
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2017-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228166207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02457821Medicaid
NYH91560Medicare UPIN
NYDD6885Medicare ID - Type Unspecified