Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 034107 | NY |
Y | 213EG0000X | General Practice | 034107 | NY |
NPI | 1003902974 |
---|---|
Provider Name | Dr. Roderick Macrae |
First Address | Patterson, NY 12563-2166 |
Second Address | Patterson, NY 12563-2166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00492824 | (05) | NY |