Healthcare Provider Details

I. General information

NPI: 1962425561
Provider Name (Legal Business Name): MARY JOYCE MCGINNIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 COMPUTER DR W
ALBANY NY
12205-1612
US

IV. Provider business mailing address

24 COMPUTER DR W
ALBANY NY
12205-1612
US

V. Phone/Fax

Practice location:
  • Phone: 518-689-7548
  • Fax: 518-489-9431
Mailing address:
  • Phone: 518-689-7548
  • Fax: 518-489-9431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0166819
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: