MEDICARE: RICHARD K MCNALLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	192980	NY

General Provider Information

NPI Number	:	1568452985
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD K MCNALLY MD

Provider Business Mailing Address
First Line	:	19 BRADHURST AVE STE 3100N
Second Line	:
City	:	HAWTHORNE
State	:	NY
Zip	:	10532-2140
Country	:	US
Telephone Number	:	914-909-9018
Fax Number	:	914-909-9028

Provider Business Practice Location Address
First Line	:	105 MARYS AVE
Second Line	:
City	:	KINGSTON
State	:	NY
Zip	:	12401-5848
Country	:	US
Telephone Number	:	845-334-4929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	04/25/2017

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