Provider Demographics
NPI:1679574388
Name:DEPAN, HARRY J (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:J
Last Name:DEPAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-525-2542
Mailing Address - Fax:518-525-2524
Practice Address - Street 1:1101 NOTT ST
Practice Address - Street 2:STE 4B
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-2425
Practice Address - Country:US
Practice Address - Phone:518-243-3610
Practice Address - Fax:518-243-3613
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2009-08-26
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Provider Licenses
StateLicense IDTaxonomies
NY147956-1208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00955862Medicaid
B14385Medicare UPIN
NY33723MMedicare ID - Type Unspecified