Organization
MAGNOLIA DERMATOLOGY, PLLC
Active
Organization
MAGNOLIA DERMATOLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIRGINIA TRACEY MD (MEMBER)
(518) 888-2012
Entity
Organization
Contact information
Practice address
582 NEW LOUDON RD, LATHAM, NY 12110-4059
(518) 888-2012
Mailing address
1 LOUDON HTS S, LOUDONVILLE, NY 12211-2013
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
07/21/2023
Last updated
05/13/2024
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