Provider Demographics
NPI:1295906345
Name:ALBIN, DMITRY ANATOLYEVICH (MD)
Entity type:Individual
Prefix:
First Name:DMITRY
Middle Name:ANATOLYEVICH
Last Name:ALBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 OLD PARK LANE RD
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-2507
Mailing Address - Country:US
Mailing Address - Phone:860-355-1149
Mailing Address - Fax:860-210-2008
Practice Address - Street 1:11 OLD PARK LANE RD
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-2507
Practice Address - Country:US
Practice Address - Phone:860-355-1149
Practice Address - Fax:860-210-2008
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 100204207R00000X
ME018696207R00000X
CT53878207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT53878OtherMEDICAL LICENSE
FLME100204OtherMEDICAL LICIENSE