Provider Demographics
NPI:1467433797
Name:DADIAN, NISHAN (MD)
Entity Type:Individual
Prefix:
First Name:NISHAN
Middle Name:
Last Name:DADIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:391 MYRTLE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3797
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:PRUYN PAVILION AT GLENS FALLS HOSPITAL
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4449
Practice Address - Country:US
Practice Address - Phone:518-792-7122
Practice Address - Fax:518-792-3800
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY2129582086S0129X, 2085R0204X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02672466Medicaid
NY1N1341Medicare ID - Type UnspecifiedDOWNSTATE
H87321Medicare UPIN
NY02672466Medicaid