Kavita Menon, M.D.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

245879-1 Issued in NY

Practice address

582 New Loudon Rd
Latham, NY 12110-4059

Phone

(518) 875-3376

NPI assigned

Aug 4, 2008

Last updated

May 1, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

New York University School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Magnolia Dermatology, PLLCGroup PAC ID 8123560679, 4 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Magnolia Dermatology, PLLC

  • Dermatology Physician
  • Latham, NY
  • NPI 1932889102
  Medicare reassignment Care Compare group NPD
• Theta Pattison MD

  • Dermatology Physician
  • Altamont, NY
  • NPI 1942292925
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1217808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714521600000",
    "number": "1275799801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 EXECUTIVE PARK DRIVE 2ND FLOOR",
            "city": "ALBANY",
            "state": "NY",
            "postal_code": "122033700",
            "telephone_number": "518-482-8631",
            "fax_number": "184-820-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "582 NEW LOUDON RD",
            "city": "LATHAM",
            "state": "NY",
            "postal_code": "121104059",
            "telephone_number": "518-875-3376"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2 Executive Park Dr",
            "address_2": "2nd Fl",
            "address_purpose": "LOCATION",
            "city": "Albany",
            "state": "NY",
            "postal_code": "122031220",
            "country_code": "US",
            "telephone_number": "518-482-8631",
            "fax_number": "518-820-1734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MENON",
        "first_name": "KAVITA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-04",
        "last_updated": "2024-05-01",
        "certification_date": "2024-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NY",
            "license": "245879-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Anne Medici, RN
• Medimil Inc
• Manish Mehta, MD
• Gabriela Melillo
• Helen Donna Menge, CNM, NP
• Linda Mensah
• Angela Mercer, LCSW
• Lauren Merola, CCC-LSLP
• Edward Charles Merritt, MA
• Julianne Messier, OTR/L

• Dermatology Physician in Latham, NY
• Providers in Latham, NY by specialty
• Dermatology Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.