Provider Demographics
NPI:1003860339
Name:BUCHANAN, MARA J (PA)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:J
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:2546 BALLTOWN RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12309-1079
Mailing Address - Country:US
Mailing Address - Phone:518-377-8198
Mailing Address - Fax:518-377-0620
Practice Address - Street 1:1205 TROY SCHENECTADY RD STE 101
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-1074
Practice Address - Country:US
Practice Address - Phone:518-348-3176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2019-10-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY003087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant