Healthcare Provider Details

I. General information

NPI: 1558680504
Provider Name (Legal Business Name): SUSAN PENG DEMAREST MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2010
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 WASHINGTON AVENUE EXT
ALBANY NY
12203-5316
US

IV. Provider business mailing address

220 WASHINGTON AVENUE EXT
ALBANY NY
12203-5316
US

V. Phone/Fax

Practice location:
  • Phone: 518-489-4704
  • Fax: 518-489-0512
Mailing address:
  • Phone: 518-489-4704
  • Fax: 518-489-0512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number277624
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: