Healthcare Provider Details

I. General information

NPI: 1265424279
Provider Name (Legal Business Name): MARY E RAPPAZZO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 PALISADES DR SUITE 100
ALBANY NY
12205-1443
US

IV. Provider business mailing address

4 PALISADES DR SUITE 100
ALBANY NY
12205-1443
US

V. Phone/Fax

Practice location:
  • Phone: 518-446-9545
  • Fax: 518-446-9551
Mailing address:
  • Phone: 518-446-9545
  • Fax: 518-446-9551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number139572
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number139572
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: