=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154467462
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FE TERESA J. MCCARTHY, MD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 951 ALBANY SHAKER RD
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-220-2022
-----------------------------------------------------
Fax | 518-220-9263
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 951 ALBANY SHAKER RD
-----------------------------------------------------
City | LATHAM
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12110-1409
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 518-220-2022
-----------------------------------------------------
Fax | 518-220-9263
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOY AQUINO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 518-220-2022
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 117422
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------