MEDICARE: TESSA LABOUNTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207Q00000X	Family Medicine Physician	312105	NY

General Provider Information

NPI Number	:	1831757723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TESSA LABOUNTY MD

Provider Business Mailing Address
First Line	:	6 WELLNESS WAY STE 203
Second Line	:
City	:	LATHAM
State	:	NY
Zip	:	12110-2156
Country	:	US
Telephone Number	:	518-782-3700
Fax Number	:	518-782-3799

Provider Business Practice Location Address
First Line	:	4164 NY 2
Second Line	:
City	:	TROY
State	:	NY
Zip	:	12180-9029
Country	:	US
Telephone Number	:	518-213-0450
Fax Number	:	518-279-1716

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/05/2019
Last Update Date	:	04/06/2026

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Directions to “ TESSA LABOUNTY MD” Practice Location

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