Provider Demographics
NPI:1235318247
Name:BITTING, LAURIE A (RPA-C)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:A
Last Name:BITTING
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 1:1301 TRUMANSBURG RD
Mailing Address - Street 2:SUITE P
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1397
Mailing Address - Country:US
Mailing Address - Phone:607-277-2365
Mailing Address - Fax:
Practice Address - Street 1:1122 COMMONS AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1643
Practice Address - Country:US
Practice Address - Phone:607-428-8004
Practice Address - Fax:607-428-8003
Is Sole Proprietor?:No
Enumeration Date:2007-10-25
Last Update Date:2015-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012212363A00000X
VA0110003368363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235318247Medicaid
VA1235318247Medicaid