1174512743 NPI number — DR. FE TERESA MCCARTHY M.D.

Table of content: DR. FE TERESA MCCARTHY M.D. (NPI 1174512743)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174512743 NPI number — DR. FE TERESA MCCARTHY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCCARTHY
Provider First Name:
FE TERESA
Provider Middle Name:
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:
DE JESUS-MCCARTHY
Provider Other First Name:
FE TERESA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1174512743
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
951 ALBANY SHAKER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LATHAM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12110-1409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-220-2022
Provider Business Mailing Address Fax Number:
518-220-9263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
951 ALBANY SHAKER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LATHAM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12110-1409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-220-2022
Provider Business Practice Location Address Fax Number:
518-220-9263
Provider Enumeration Date:
10/17/2005

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: 174400000X , with the licence number:  117422 , 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)

  • Identifier: 00040458801 . This is a "UNIVERA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 50E762 . This is a "EMPIRE B/C B/S" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: TMC231123 . This is a "BLUE SHIELD CENTRAL NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000416181001 . This is a "BLUE SHIELD NENY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 10001326 . This is a "CDPHP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1308176 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5356307 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: DC4198 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000011263 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00715733 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 15128 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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