Provider Demographics
NPI:1659368090
Name:MCELRATH, TIMOTHY J (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:MCELRATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:TIMOTHY
Other - Middle Name:J
Other - Last Name:MCELRATH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:319 S MANNING BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-1742
Mailing Address - Country:US
Mailing Address - Phone:518-458-1390
Mailing Address - Fax:
Practice Address - Street 1:319 S MANNING BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1742
Practice Address - Country:US
Practice Address - Phone:518-458-1390
Practice Address - Fax:518-459-3271
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206323207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01990427Medicaid
H31807Medicare UPIN
NY01990427Medicaid