Individual
DR. MARY SUSAN ELACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
101 JORDAN RD, SUITE 200, TROY, NY 12180-8343
(518) 274-0476
(518) 274-0497
Mailing address
711 TROY SCHENECTADY RD, SUITE 203, LATHAM, NY 12110-2442
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
149514
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00020780401
UNIVERA
NY
01
—
000416081001
BLUE SHIELD
NY
01
—
0005361476
AETNA
NY
01
—
0015055
GHI
NY
05
—
00858755
—
NY
01
—
040426006334
FIDELIS
NY
01
—
10000563
CDPHP
NY
01
—
113801
WELLCARE
NY
01
—
13801
GHIHMO
NY
01
—
141655014
EMPIRE PLAN
NY
01
—
160007874
RAILROAD MEDICARE
NY
01
—
16152
MVP
NY
01
—
52E361
BLUE CROSS
NY
Enumeration date
04/27/2006
Last updated
10/06/2014
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