Magnolia Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

MAGNOLIA DERMATOLOGY, PLLC

Practice address

582 New Loudon Rd
Latham, NY 12110-4059

Phone

(518) 888-2012

NPI assigned

Jul 21, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Virginia Tracey, MDNPI 1336584523

Title

Member

Phone

(518) 888-2012

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Virginia Alldredge Tracey, M.D.

  • Dermatology Physician
  • East Syracuse, NY
  • NPI 1336584523
  Medicare reassignment Care Compare group NPD Authorized official
• Kavita Menon, M.D.

  • Dermatology Physician
  • Latham, NY
  • NPI 1275799801
  Medicare reassignment Care Compare group NPD
• Jennifer Lynne Smith, M.D.

  • Dermatology Physician
  • Saratoga Springs, NY
  • NPI 1255333522
  Medicare reassignment Care Compare group NPD
• Jacqueline Rosenbaum, PA

  • Surgical Physician Assistant
  • Albany, NY
  • NPI 1710496757
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1689897600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715558400000",
    "number": "1932889102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LOUDON HTS S",
            "city": "LOUDONVILLE",
            "state": "NY",
            "postal_code": "122112013"
        },
        {
            "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": "518-888-2012"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAGNOLIA DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-07-21",
        "last_updated": "2024-05-13",
        "certification_date": "2024-05-13",
        "status": "A",
        "authorized_official_last_name": "TRACEY",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "518-888-2012",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaelyn Madelone
• Madhu Padi
• Mythili Lakshmi Madhyastha, MS.ED.
• Mary Lou Madrick, RN
• Heather Lynn Maggio, FNP
• Adel Mahjoub, MD
• Alicia Mahler, PHD
• Ann Theresa Mahoney, RN
• David Vincent Malicki, DDS
• Joanne Malkani, PH.D.

• 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 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.