Provider Demographics
NPI:1376520627
Name:COLIHAN, LAURA CHATHERINE (RPA C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:CHATHERINE
Last Name:COLIHAN
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 1:826 WASHINGTON ST
Mailing Address - Street 2:STE 106
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4071
Mailing Address - Country:US
Mailing Address - Phone:315-786-2000
Mailing Address - Fax:315-786-2899
Practice Address - Street 1:826 WASHINGTON ST
Practice Address - Street 2:STE 106
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4071
Practice Address - Country:US
Practice Address - Phone:315-786-2000
Practice Address - Fax:315-786-2899
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0103741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02620937Medicaid
783656OtherMVP
P00181733OtherRR MEDICARE
NYPA0593Medicare ID - Type Unspecified
783656OtherMVP