Provider Demographics
NPI:1437169562
Name:GORMAN, AMY M (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:GORMAN
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:DARMETKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1438
Mailing Address - Country:US
Mailing Address - Phone:518-458-2000
Mailing Address - Fax:518-458-1524
Practice Address - Street 1:2 PALISADES DR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-1438
Practice Address - Country:US
Practice Address - Phone:518-458-2000
Practice Address - Fax:518-458-1524
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009583-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02562985Medicaid
NY02562985Medicaid
NYQ21281Medicare UPIN