Magnolia Dermatology, PLLC
NPI 1932889102ActiveOrganization· Dermatology· Latham, NY
Dermatology in Latham, New York, registered in NPPES in July 2023. The authorized official on file is Virginia Tracey, MD, Member. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1932889102 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 21, 2023 |
| Last updated in NPPES | May 13, 2024 |
| Certified by provider | May 13, 2024 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (NY) |
|---|
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