Provider Demographics
NPI:1407800352
Name:ATKINS, FREDERIC P (PA)
Entity Type:Individual
Prefix:
First Name:FREDERIC
Middle Name:P
Last Name:ATKINS
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 725
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-0725
Mailing Address - Country:US
Mailing Address - Phone:518-254-3450
Mailing Address - Fax:518-234-8449
Practice Address - Street 1:121 LEGION DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5111
Practice Address - Country:US
Practice Address - Phone:518-254-3450
Practice Address - Fax:518-234-8449
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004257363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02135880Medicaid
NYCC2929Medicare ID - Type UnspecifiedUPSTATE
NY02135880Medicaid