Provider Demographics
NPI:1316109796
Name:MCGRATH, EDMUND JOHN (DPM)
Entity type:Individual
Prefix:MR
First Name:EDMUND
Middle Name:JOHN
Last Name:MCGRATH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 CENTRAL AVENUE #24
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206
Mailing Address - Country:US
Mailing Address - Phone:917-561-4809
Mailing Address - Fax:
Practice Address - Street 1:911 CENTRAL AVENUE #24
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206
Practice Address - Country:US
Practice Address - Phone:917-561-4809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN0035851213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist