Provider Demographics
NPI:1942274659
Name:FORT, FRANK G (MD)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:G
Last Name:FORT
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 1:1537 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-6001
Mailing Address - Country:US
Mailing Address - Phone:518-377-1154
Mailing Address - Fax:518-377-1192
Practice Address - Street 1:1537 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-6001
Practice Address - Country:US
Practice Address - Phone:518-377-1154
Practice Address - Fax:518-377-1192
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY168019-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY10000674OtherCDPHP
NY000406834002OtherBLUE SHIELD NENY
NY02132OtherMVP
A16076Medicare UPIN
NY10000674OtherCDPHP