Provider Demographics
NPI:1659355204
Name:BULATAO, ISIDRO M (MD)
Entity Type:Individual
Prefix:DR
First Name:ISIDRO
Middle Name:M
Last Name:BULATAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHESHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2619
Mailing Address - Country:US
Mailing Address - Phone:518-785-8171
Mailing Address - Fax:
Practice Address - Street 1:190 5TH AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1017
Practice Address - Country:US
Practice Address - Phone:518-235-3990
Practice Address - Fax:518-235-9177
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097438208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000230OtherCDPHP
NY00529300Medicaid
40096BMedicare ID - Type Unspecified
B82665Medicare UPIN