Provider Demographics
NPI:1033205364
Name:FLUTY, BARBARA A (PA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:A
Last Name:FLUTY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NY
Mailing Address - Zip Code:13323-1218
Mailing Address - Country:US
Mailing Address - Phone:315-859-4111
Mailing Address - Fax:315-859-4963
Practice Address - Street 1:198 COLLEGE HILL RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NY
Practice Address - Zip Code:13323-1218
Practice Address - Country:US
Practice Address - Phone:315-859-4111
Practice Address - Fax:315-859-4963
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005658363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S32430Medicare UPIN