Provider Demographics
NPI:1003979121
Name:AZAD, ABUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:ABUL
Middle Name:K
Last Name:AZAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309
Practice Address - Country:US
Practice Address - Phone:518-831-8530
Practice Address - Fax:518-831-8545
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2021-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204594207R00000X, 208M00000X, 207RP1001X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01759833Medicaid
NY10020530OtherCDPHP
NY135032OtherGHI/HMO
NY200852OtherSENIOR WHOLE HEALTH
NY6022794OtherMVP HEALTHCARE
NY7542070OtherAETNA
NY28R331OtherEMPIRE BC
NY000471066006OtherBSNENY
NY090226000061OtherFIDELIS
NYBB6153Medicare ID - Type Unspecified
NY28R331OtherEMPIRE BC
NY01759833Medicaid
NYJ400002882Medicare PIN