Provider Demographics
NPI:1932191772
Name:UPSTATE UROLOGY
Entity Type:Organization
Organization Name:UPSTATE UROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:BARADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-446-9838
Mailing Address - Street 1:PO BOX 8701
Mailing Address - Street 2:UPSTATE UROLOGY
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-0701
Mailing Address - Country:US
Mailing Address - Phone:518-446-9838
Mailing Address - Fax:
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-446-9838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ300043978Medicare PIN