Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | F001443 | NY |
NPI | 1083906481 |
---|---|
Provider Name | Elizabeth Ketcham Mercogliano |
First Address | Albany, NY 12202-1703 |
Second Address | Albany, NY 12202-1703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2011 |
Last Update Date | 25/05/2011 |