Provider Demographics
NPI:1548357866
Name:UPSTATE INTERNAL MEDICINE AND PEDIATRICS P C
Entity type:Organization
Organization Name:UPSTATE INTERNAL MEDICINE AND PEDIATRICS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-458-7212
Mailing Address - Street 1:1365 WASHINGTON AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1098
Mailing Address - Country:US
Mailing Address - Phone:518-458-7212
Mailing Address - Fax:518-689-0258
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-458-7212
Practice Address - Fax:518-689-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197219208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty