Provider Demographics
NPI:1124018452
Name:COTTON, MELISSA GAIL (RPA C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAIL
Last Name:COTTON
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Gender:F
Credentials:RPA C
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Mailing Address - Street 1:25 WILLOWBROOK RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-5882
Mailing Address - Country:US
Mailing Address - Phone:518-793-9156
Mailing Address - Fax:518-793-6591
Practice Address - Street 1:25 WILLOWBROOK RD
Practice Address - Street 2:SUITE 2
Practice Address - City:QUEENSBURY
Practice Address - State:NY
Practice Address - Zip Code:12804-5882
Practice Address - Country:US
Practice Address - Phone:518-793-9156
Practice Address - Fax:518-793-6591
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-05-04
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Provider Licenses
StateLicense IDTaxonomies
NY008509363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02380683Medicaid