Provider Demographics
NPI:1063451854
Name:MCLAUGHLIN, KELLY M (RPAC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:M
Last Name:MCLAUGHLIN
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13905
Mailing Address - Country:US
Mailing Address - Phone:607-798-5111
Mailing Address - Fax:607-563-2663
Practice Address - Street 1:169 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13905
Practice Address - Country:US
Practice Address - Phone:607-798-5111
Practice Address - Fax:607-563-2663
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008397363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY8L5L6Medicare ID - Type UnspecifiedDOWNSTATE
NYQ53946Medicare UPIN