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General NPI Number Information
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NPI Number | 1659332575
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Entity Type | Individual
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Provider Name | MARY KYLE DYER-MARTIN DO
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Gender | Female
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Dates
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Enumeration Date | 03/30/2006
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Last Update Date | 05/12/2021
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Provider Practice Location Address
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Address Line | 2 EMPIRE DR SUITE 100
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City | RENSSELAER
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State | NY
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Zip | 12144-5730
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Country | US
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Telephone | 518-286-4899
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Fax | 518-286-4859
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Provider Business Mailing Address
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Address Line | PO BOX 14890
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City | ALBANY
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State | NY
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Zip | 12212-4890
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Country | US
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Telephone | 518-525-5634
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Fax | 518-649-4094
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 212822
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License Number State | NY
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