Provider Demographics
NPI:1083784961
Name:PANZETTA, MARY TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:TERESA
Last Name:PANZETTA
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 1:2 TOWER PL
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3735
Mailing Address - Country:US
Mailing Address - Phone:518-438-5501
Mailing Address - Fax:
Practice Address - Street 1:2 TOWER PL
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3735
Practice Address - Country:US
Practice Address - Phone:518-438-5501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1718252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF79033Medicare UPIN
NYDD1782Medicare ID - Type Unspecified