Provider Demographics
NPI:1609959295
Name:ACOME, M. RICHARD (PA)
Entity Type:Individual
Prefix:
First Name:M. RICHARD
Middle Name:
Last Name:ACOME
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 1:6254 LAWVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:14590-9792
Mailing Address - Country:US
Mailing Address - Phone:315-594-9444
Mailing Address - Fax:315-594-1315
Practice Address - Street 1:6254 LAWVILLE RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:NY
Practice Address - Zip Code:14590-9792
Practice Address - Country:US
Practice Address - Phone:315-594-9444
Practice Address - Fax:315-594-1315
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02650264Medicaid
NYS15962Medicare UPIN
NYD76001Medicare PIN