Healthcare Provider Details

I. General information

NPI: 1689981920
Provider Name (Legal Business Name): MARIA MARGARITA PESQUERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS MARIA MARGARITA PESQUERA TEISSONNIERE

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 NEW KARNER RD
ALBANY NY
12205-3809
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-285-5815
  • Fax:
Mailing address:
  • Phone: 518-525-5634
  • Fax: 518-649-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number208107
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number208107
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: