Provider Demographics
NPI:1508314824
Name:BAXTER, BRITTANY ANN
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-3309
Mailing Address - Country:US
Mailing Address - Phone:518-745-5280
Mailing Address - Fax:518-745-5284
Practice Address - Street 1:2 EXECUTIVE PARK DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3700
Practice Address - Country:US
Practice Address - Phone:518-482-8631
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06277361Medicaid