Provider Demographics
NPI:1356850820
Name:MACLACHLAN, GAVIN JOHN (EMT)
Entity Type:Individual
Prefix:
First Name:GAVIN
Middle Name:JOHN
Last Name:MACLACHLAN
Suffix:
Gender:M
Credentials:EMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 DOWNING RD
Mailing Address - Street 2:
Mailing Address - City:DE WITT
Mailing Address - State:NY
Mailing Address - Zip Code:13214-1547
Mailing Address - Country:US
Mailing Address - Phone:315-530-2733
Mailing Address - Fax:
Practice Address - Street 1:115 DOWNING RD
Practice Address - Street 2:
Practice Address - City:DE WITT
Practice Address - State:NY
Practice Address - Zip Code:13214-1547
Practice Address - Country:US
Practice Address - Phone:315-530-2733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265391146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY265391OtherEMERGENCY MEDICAL TECHNICIAN