Healthcare Provider Details

I. General information

NPI: 1174512743
Provider Name (Legal Business Name): FE TERESA MCCARTHY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FE TERESA DE JESUS-MCCARTHY M.D

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 02/01/2023
Certification Date: 02/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 ALBANY SHAKER RD
LATHAM NY
12110-1409
US

IV. Provider business mailing address

951 ALBANY SHAKER RD
LATHAM NY
12110-1409
US

V. Phone/Fax

Practice location:
  • Phone: 518-220-2022
  • Fax: 518-220-9263
Mailing address:
  • Phone: 518-220-2022
  • Fax: 518-220-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number117422
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: