Provider Demographics
NPI:1982694154
Name:FERNANDO, MARIA TERESITA P (MD)
Entity Type:Individual
Prefix:
First Name:MARIA TERESITA
Middle Name:P
Last Name:FERNANDO
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:PO BOX 1461
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-8961
Mailing Address - Country:US
Mailing Address - Phone:518-786-6816
Mailing Address - Fax:518-786-1293
Practice Address - Street 1:2210 TROY SCHENECTADY RD
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-4725
Practice Address - Country:US
Practice Address - Phone:518-346-9478
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136145207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83021Medicare UPIN