Provider Demographics
NPI:1629610050
Name:MENON, DRUCE V (PA-C)
Entity Type:Individual
Prefix:
First Name:DRUCE
Middle Name:V
Last Name:MENON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:607-432-2000
Mailing Address - Fax:607-431-5683
Practice Address - Street 1:1 NORTON AVE
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-2629
Practice Address - Country:US
Practice Address - Phone:607-432-2000
Practice Address - Fax:607-431-5683
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57173363A00000X
NY026144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant