1801154307 NPI number — DR. DORCAS BOAHEMA PINTO M.D.

Table of content: DR. DORCAS BOAHEMA PINTO M.D. (NPI 1801154307)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801154307 NPI number — DR. DORCAS BOAHEMA PINTO M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PINTO
Provider First Name:
DORCAS
Provider Middle Name:
BOAHEMA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801154307
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
47 NEW SCOTLAND AVE
Provider Second Line Business Mailing Address:
DEPARTMENT OF EMMEDICINEERGENCY
Provider Business Mailing Address City Name:
ALBANY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12208-3412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-262-3095
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
47 NEW SCOTLAND AVE
Provider Second Line Business Practice Location Address:
DEPARTMENT OF EMERGENCY MEDICINE
Provider Business Practice Location Address City Name:
ALBANY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12208-3412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-262-3095
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , with the licence number:  63237 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 274667 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)