MEDICARE: CATHERINE MACOMBER

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1861808966
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CATHERINE MACOMBER

Provider Business Mailing Address
First Line	:	1430 WESTERN AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-3422
Country	:	US
Telephone Number	:	518-453-0806
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 WESTERN AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12203-3422
Country	:	US
Telephone Number	:	518-453-0806
Fax Number	:

Authorized Official
Title or Position	:	RN
Name	:	MRS. CATHERINE PARDY MACOMBER
Credential	:
Telephone Number	:	518-274-7707

Provider Enumeration Date	:	07/09/2014
Last Update Date	:	07/09/2014

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Directions to “CATHERINE MACOMBER ” Practice Location

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