Provider Demographics
NPI:1295702967
Name:ROY, MARY PATRICIA (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:ROY
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 1:113 HOLLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3410
Mailing Address - Country:US
Mailing Address - Phone:518-626-6415
Mailing Address - Fax:
Practice Address - Street 1:325B KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2370
Practice Address - Country:US
Practice Address - Phone:413-586-0611
Practice Address - Fax:413-586-4441
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58173207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA74-3087553OtherNORTH AMERICAN PREFERRED
MAJ16604OtherBCBSMA
D87946Medicare UPIN
MA4248783OtherAETNA
MA74-3087553OtherNORTHEAST HEALTHCARE ALLI
MA5282OtherHARVARD PILGRIM
MA74-3087553OtherGREAT-WEST
MA74-3087553OtherUNICARE/GIC
MA0084007-002OtherCIGNA
MA17116OtherHEALTH NEW ENGLAND
MA74-3087553OtherCONSOLIDATED
MA74-3087553OtherPLAN VISTA
MA765912OtherTUFTS
MA045528OtherCONNECTICARE
MA74-3087553OtherPRIVATE HEALTHCARE SYSTEM
J08144Medicare ID - Type Unspecified
MA3076873Medicaid
MA000000025496OtherBMC