Provider Demographics
NPI:1518277201
Name:DESMOND, MARTHA ANN (NP)
Entity Type:Individual
Prefix:MRS
First Name:MARTHA
Middle Name:ANN
Last Name:DESMOND
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 WEATHERWAX RD
Mailing Address - Street 2:
Mailing Address - City:POESTENKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12140-2710
Mailing Address - Country:US
Mailing Address - Phone:518-283-5001
Mailing Address - Fax:
Practice Address - Street 1:47 NEW SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-3412
Practice Address - Country:US
Practice Address - Phone:518-262-8328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF430504-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care