Provider Demographics
NPI:1750313318
Name:SAMUELS, ALAN MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MICHAEL
Last Name:SAMUELS
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 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1056
Mailing Address - Country:US
Mailing Address - Phone:518-438-4483
Mailing Address - Fax:518-482-4201
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1056
Practice Address - Country:US
Practice Address - Phone:518-438-4483
Practice Address - Fax:518-482-4201
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116086207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology