Provider Demographics
NPI:1447567649
Name:NIETSCH, HUBERTUS HEINRICH (MD)
Entity Type:Individual
Prefix:DR
First Name:HUBERTUS
Middle Name:HEINRICH
Last Name:NIETSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:355 STATE ST
Mailing Address - Street 2:3EF
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12210-1242
Mailing Address - Country:US
Mailing Address - Phone:518-894-4640
Mailing Address - Fax:
Practice Address - Street 1:47 NEW SCOTLAND AVE # MC48
Practice Address - Street 2:PYSICIANS PAVILLION, 4TH FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-5276
Practice Address - Fax:518-262-6470
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-09
Last Update Date:2011-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY003676207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology