Provider Demographics
NPI:1619946258
Name:MEHTABDIN, DURDANA (MD)
Entity Type:Individual
Prefix:DR
First Name:DURDANA
Middle Name:
Last Name:MEHTABDIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 WESTERN AVE
Mailing Address - Street 2:GUILDERLAND FAMILY PRACTICE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203
Mailing Address - Country:US
Mailing Address - Phone:518-464-9000
Mailing Address - Fax:518-464-9200
Practice Address - Street 1:2022 WESTERN AVE
Practice Address - Street 2:GUILDERLAND FAMILY PRACTICE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203
Practice Address - Country:US
Practice Address - Phone:518-464-9000
Practice Address - Fax:518-464-9200
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168137207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
085447OtherMVP
1681378WOtherWORKERS COMP
72562OtherGHI HMO
5209A1OtherEMPIRE BLUE CROSS BLUE SH
NY000401327017OtherBLUE SHIELD OF NORTHEASTE
5903957OtherGHI PPO
040426006292OtherFIDELIS
267622OtherWELLCARE
NY01061729Medicaid
10005965OtherCDPHP
5903957OtherGHI PPO
NY01061729Medicaid
P00105416Medicare ID - Type UnspecifiedRAILROAD