Provider Demographics
NPI:1083970149
Name:AGRICOLA, CATHERINE DAILEY (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:DAILEY
Last Name:AGRICOLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:MOLINA
Other - Last Name:DAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:347 FULLERTON AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3700
Mailing Address - Country:US
Mailing Address - Phone:845-510-1870
Mailing Address - Fax:845-510-1872
Practice Address - Street 1:347 FULLERTON AVE STE 1
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3700
Practice Address - Country:US
Practice Address - Phone:845-510-1870
Practice Address - Fax:845-510-1872
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-03
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276829208000000X, 208D00000X, 207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04485723Medicaid
NY04485723Medicaid