Provider Demographics
NPI:1982640355
Name:ALBATROSOV, ALBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:A
Last Name:ALBATROSOV
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 1:21 KALANIANAOLE AVE
Mailing Address - Street 2:BLDG C
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-4770
Mailing Address - Country:US
Mailing Address - Phone:808-930-0777
Mailing Address - Fax:808-930-0770
Practice Address - Street 1:21 KALANIANAOLE AVE
Practice Address - Street 2:BLDG C
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4770
Practice Address - Country:US
Practice Address - Phone:808-930-0777
Practice Address - Fax:808-930-0770
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41127204C00000X
HI56962084P0800X, 2084P0802X, 208U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14045Medicare PIN
FLD21346Medicare UPIN