Provider Demographics
NPI:1689981920
Name:PESQUERA, MARIA MARGARITA (MD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:MARGARITA
Last Name:PESQUERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:MARGARITA
Other - Last Name:PESQUERA TEISSONNIERE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 14890
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12212-4890
Mailing Address - Country:US
Mailing Address - Phone:518-525-5634
Mailing Address - Fax:518-649-4094
Practice Address - Street 1:445 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3809
Practice Address - Country:US
Practice Address - Phone:518-285-5815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208107207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01986983Medicaid
NY01986983Medicaid
NYJ400028688Medicare PIN