Provider Demographics
NPI:1881683134
Name:BLAIR, ALBERT JOHN III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:JOHN
Last Name:BLAIR
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:117 MARYS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5849
Mailing Address - Country:US
Mailing Address - Phone:845-338-3050
Mailing Address - Fax:845-338-1614
Practice Address - Street 1:117 MARYS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-3050
Practice Address - Fax:845-338-1614
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY167133208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY978950Medicaid
NYA64461Medicare UPIN
NY978950Medicaid