Provider Demographics
NPI:1679531289
Name:FORD, JOCKULAR BRADY (MD)
Entity type:Individual
Prefix:DR
First Name:JOCKULAR
Middle Name:BRADY
Last Name:FORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:711 TROY SCHENECTADY RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2442
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:101 JORDAN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8343
Practice Address - Country:US
Practice Address - Phone:518-274-0476
Practice Address - Fax:518-274-0497
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2013-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY127727207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0005367485OtherAETNA
NY00040400801OtherUNIVERA
NY141655014OtherUNITED HEALTHCARE
NY040426006337OtherFIDELIS
NY10000669OtherCDPHP
NY45520OtherGHIHMO
NY00298971Medicaid
NY160011356OtherRAILROAD MEDICARE
NY110129OtherWELLCARE
NY16151OtherMVP
NY000416095001OtherBLUE SHIELD
NY0015055OtherGHI
NY141655014OtherEMPIRE PLAN
NY50Z111OtherBLUE CROSS
NYJ400034835Medicare PIN
NY110129OtherWELLCARE
NY141655014OtherUNITED HEALTHCARE