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MAGNOLIA DERMATOLOGY, PLLC
NPI 1932889102
Dermatology in Latham, NY

Active since July 21, 2023CLIA 33D2340140 · Certificate of Compliance
582 NEW LOUDON RD, LATHAM, NY 12110(518) 888-2012 Get Directions Write a Review

NPPES record last updated: May 13, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 13, 2024, May 1, 2024, Jul 21, 2023 (3 updates tracked since 2023).

About Magnolia Dermatology, Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MAGNOLIA DERMATOLOGY, PLLC (NPI 1932889102) is a healthcare organization registered as a dermatology in Latham, New York and active in the NPI registry since July 2023. The organization holds a CLIA Certificate of Compliance certificate valid through March 11, 2028 and lists Virginia Tracey, Member, as its authorized official.

NPPES Registry Identity

NPI1932889102
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameMAGNOLIA DERMATOLOGY, PLLC
Location Address582 NEW LOUDON RDLatham, NY 12110-4059
Mailing Address1 Loudon Hts SLoudonville, NY 12211-2013
Phone(518) 888-2012
Organization SubpartNo
Authorized OfficialVirginia TraceyMember · (518) 888-2012
Enumeration DateJuly 21, 2023
Last NPPES UpdateMay 13, 20243 updates tracked since enumeration
NPPES CertifiedMay 13, 2024
✔ NPI 1932889102 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
582 NEW LOUDON RD, Latham, NY 12110
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 33D2340140

Magnolia Dermatology · Latham, NY
Active · expires Mar 11, 2028
CLIA Number33D2340140
Laboratory TypePhysician Office
Certificate Effective DateMarch 12, 2026
Certificate Expiration DateMarch 11, 2028
Laboratory DirectorJennifer Smith
Laboratory Phone(518) 875-3376
Laboratory LocationMagnolia Dermatology582 New Loudon Road, Latham, NY 12110
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

PRIME CARE PHYSICIANS, P.L.L.C.
Internal Medicine
582 NEW LOUDON RD
LATHAM, NY 12110
Albany County (518) 783-0072
DR. RORICK T RIMASH M.D.
Internal Medicine
582 NEW LOUDON RD
LATHAM, NY 12110
Albany County (518) 783-0072
ST. PETER'S HEALTH PARTNERS MEDICAL ASSOCIATES, P.C.
Internal Medicine
582 NEW LOUDON RD, ST PETER'S INTERNAL MEDICINE
LATHAM, NY 12110
Albany County (518) 783-0072
MS. MAUREEN MARY SULLIVAN MSW, CSW-R
Social Worker (Clinical)
582 NEW LOUDON RD
LATHAM, NY 12110
Albany County (518) 783-6059
ALBANY HEALTH MANAGEMENT ASSOCIATES, INC.
Specialist
582 NEW LOUDON RD
LATHAM, NY 12110
Albany County (518) 482-0422
PATRICIA A. FENNELL LCSW-R
Social Worker (Clinical)
582 NEW LOUDON RD
LATHAM, NY 12110
Albany County (518) 482-0422
KATHLEEN M MARSHALL NP
Nurse Practitioner (Family)
582 NEW LOUDON RD
LATHAM, NY 12110
Albany County (518) 389-7133

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Magnolia Dermatology, PLLC's NPI number?

The NPI number for Magnolia Dermatology, PLLC is 1932889102. It was assigned to this organization in the NPPES registry on July 21, 2023.

Where is Magnolia Dermatology, PLLC located?

Magnolia Dermatology, PLLC is located at 582 New Loudon Rd, Latham, NY 12110. The listed phone number is (518) 888-2012.

What is Magnolia Dermatology, PLLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Magnolia Dermatology, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 33D2340140) is associated with this NPI, valid through March 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Magnolia Dermatology, PLLC was last updated on May 13, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.