Provider Demographics
NPI:1922099803
Name:LEUPOLD, ROBERT G I (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:LEUPOLD
Suffix:I
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 1:121 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1447
Mailing Address - Country:US
Mailing Address - Phone:518-453-9088
Mailing Address - Fax:518-689-3896
Practice Address - Street 1:530 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12305-2014
Practice Address - Country:US
Practice Address - Phone:518-382-7200
Practice Address - Fax:518-382-7205
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105206207X00000X, 207XS0114X, 207XX0004X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
No207XX0004XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryFoot and Ankle Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00530369Medicaid
56356IMedicare ID - Type Unspecified
56356AMedicare ID - Type UnspecifiedGROUP
NY00530369Medicaid
56357AMedicare ID - Type UnspecifiedCLIFTON PARK-GROUP
NY56357IMedicare ID - Type UnspecifiedCPK