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General NPI Number Information
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NPI Number | 1861801862
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Entity Type | Organization
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Legal Business Name | MARY DYER MD PLLC
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Dates
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Enumeration Date | 08/05/2014
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 5 LAFKO DR
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-1413
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Country | US
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Telephone | 845-905-9389
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Fax | 845-302-8648
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Provider Business Mailing Address
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Address Line | 5 LAFKO DR
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City | POUGHKEEPSIE
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State | NY
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Zip | 12603-1413
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Country | US
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Telephone | 845-905-9389
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Fax | 845-302-8648
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Authorized Official
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Title or Position | SOLE PROPRIETOR
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Name | DR. MARY ELLEN DYER
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Credential | MD
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Telephone | 845-905-9389
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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 | 208649
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License Number State | NY
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