Healthcare Provider Details

I. General information

NPI: 1437311677
Provider Name (Legal Business Name): MARY ELISABETH FAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 09/18/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 NEW SCOTLAND AVE # 101
ALBANY NY
12208-3412
US

IV. Provider business mailing address

43 NEW SCOTLAND AVE # MC101
ALBANY NY
12208-3478
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-3125
  • Fax:
Mailing address:
  • Phone: 518-262-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number261801
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: