Provider Demographics
NPI:1396730388
Name:LO, ALBERT CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:CHARLES
Last Name:LO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2900 E 29TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2623
Mailing Address - Country:US
Mailing Address - Phone:217-355-0926
Mailing Address - Fax:217-355-1801
Practice Address - Street 1:8441 STATE HIGHWAY 47 STE 1400
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77807-3208
Practice Address - Country:US
Practice Address - Phone:979-774-8200
Practice Address - Fax:877-607-5854
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36-090682174400000X
TXS70912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01032028OtherBCBS
TX1D7195OtherMEDICARE
TX412995901Medicaid