Provider Demographics
NPI:1093721086
Name:MORRIS-DICKINSON, GWENDOLYN S (PA-C)
Entity Type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:S
Last Name:MORRIS-DICKINSON
Suffix:
Gender:F
Credentials:PA-C
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Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:100 PARK STREET
Practice Address - Street 2:GLENS FALLS HOSPITAL - HOSPITALIST PROGRAM
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4413
Practice Address - Country:US
Practice Address - Phone:518-926-5925
Practice Address - Fax:518-926-5917
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009223363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03272144Medicaid
NY03272144Medicaid