Healthcare Provider Details

I. General information

NPI: 1912911835
Provider Name (Legal Business Name): EUGENE J MCTIERNAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3767 MAIN ST
WARRENSBURG NY
12885-1890
US

IV. Provider business mailing address

9 CAREY RD
QUEENSBURY NY
12804-7880
US

V. Phone/Fax

Practice location:
  • Phone: 518-623-2844
  • Fax: 518-623-3416
Mailing address:
  • Phone: 518-761-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number192063
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: