Provider Demographics
NPI:1962425561
Name:MCGINNIS, MARY JOYCE (MD)
Entity type:Individual
Prefix:
First Name:MARY JOYCE
Middle Name:
Last Name:MCGINNIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 COMPUTER DR W
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1612
Mailing Address - Country:US
Mailing Address - Phone:518-689-7548
Mailing Address - Fax:518-489-9431
Practice Address - Street 1:24 COMPUTER DR W
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1612
Practice Address - Country:US
Practice Address - Phone:518-689-7548
Practice Address - Fax:518-489-9431
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0166819207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01340427Medicaid
NY01340427Medicaid