Healthcare Provider Details

I. General information

NPI: 1790164150
Provider Name (Legal Business Name): KATHERINE NINA RIEDY-GRAVES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE NINA RIEDY MD

II. Dates (important events)

Enumeration Date: 05/19/2015
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2546 BALLTOWN RD STE 300
SCHENECTADY NY
12309-1079
US

IV. Provider business mailing address

PO BOX 14890
ALBANY NY
12212-4890
US

V. Phone/Fax

Practice location:
  • Phone: 518-377-8184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number289423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: