Provider Demographics
NPI:1568454973
Name:BLAIR, DEBRA (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:
Last Name:BLAIR
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3485 HEATHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-2131
Mailing Address - Country:US
Mailing Address - Phone:716-648-6441
Mailing Address - Fax:716-982-5510
Practice Address - Street 1:2625 HARLEM RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-4031
Practice Address - Country:US
Practice Address - Phone:716-895-4400
Practice Address - Fax:716-892-5510
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007130363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant