Provider Demographics
NPI:1578902649
Name:PREVO, WILLIAM P (PA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:P
Last Name:PREVO
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:23 HAMMOND LN
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-2000
Mailing Address - Country:US
Mailing Address - Phone:518-561-1322
Mailing Address - Fax:518-561-3420
Practice Address - Street 1:23 HAMMOND LN
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2000
Practice Address - Country:US
Practice Address - Phone:518-561-1322
Practice Address - Fax:518-561-3420
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYP88251363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant