Healthcare Provider Details

I. General information

NPI: 1831401413
Provider Name (Legal Business Name): DEBBIE LEAH FLAHERTY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 MEDICAL PARK DR SUITE 206
MALTA NY
12020-5051
US

IV. Provider business mailing address

6 MEDICAL PARK DR SUITE 206
MALTA NY
12020-5051
US

V. Phone/Fax

Practice location:
  • Phone: 518-289-2718
  • Fax:
Mailing address:
  • Phone: 518-289-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number251017
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: