Provider Demographics
NPI:1053308809
Name:MARSH, PATRICIA (RPA-C)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MARSH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WASHINGTON AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1098
Mailing Address - Country:US
Mailing Address - Phone:518-489-4704
Mailing Address - Fax:518-489-0512
Practice Address - Street 1:1365 WASHINGTON AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1098
Practice Address - Country:US
Practice Address - Phone:518-489-4704
Practice Address - Fax:518-489-0512
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004449363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02217027Medicaid
NY02217027Medicaid