Provider Demographics
NPI:1659702314
Name:RAASCH, LYNDSAY (PA)
Entity Type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:RAASCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4939 BRITTONFIELD PKWY
Mailing Address - Street 2:BLDG B., STE. 210
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-9208
Mailing Address - Country:US
Mailing Address - Phone:315-471-8404
Mailing Address - Fax:
Practice Address - Street 1:4939 BRITTONFIELD PKWY
Practice Address - Street 2:BLDG B., STE. 210
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057-9208
Practice Address - Country:US
Practice Address - Phone:315-471-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant