Provider Demographics
NPI:1376678243
Name:OLMSTEAD, ALAN BRUCE (RPA-C)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:BRUCE
Last Name:OLMSTEAD
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
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Mailing Address - Street 1:29 ELLSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-1419
Mailing Address - Country:US
Mailing Address - Phone:518-475-5033
Mailing Address - Fax:518-475-5793
Practice Address - Street 1:1 NORYL AVE
Practice Address - Street 2:
Practice Address - City:SELKIRK
Practice Address - State:NY
Practice Address - Zip Code:12158-9765
Practice Address - Country:US
Practice Address - Phone:518-475-5033
Practice Address - Fax:518-475-5793
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY000724-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical