Individual
MICAELA NORDHAUSER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
7B JOHNSON RD, LATHAM, NY 12110-3003
(518) 782-7733
Mailing address
711 TROY SCHENECTADY RD STE 203, LATHAM, NY 12110-2461
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
2080P0006X
Developmental - Behavioral Pediatrics Physician
Primary
179338
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00179338
—
NY
05
—
01699889
—
NY
01
—
10001482
CDPHP
—
01
—
18CAB1
EMPIRE BLUECROSS BLUESHIELD
NY
01
—
26028
MVP
—
01
—
7048276
AETNA
NY
Enumeration date
05/09/2006
Last updated
01/19/2018
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