Provider Demographics
NPI:1780641845
Name:DUMAS, LORI (PA)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:DUMAS
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:PO BOX 689
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12181-0689
Mailing Address - Country:US
Mailing Address - Phone:518-268-5000
Mailing Address - Fax:
Practice Address - Street 1:1300 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1628
Practice Address - Country:US
Practice Address - Phone:518-268-5542
Practice Address - Fax:518-268-5324
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002634363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ23145Medicare UPIN
NYPA0459Medicare ID - Type Unspecified
NYPA0459Medicare PIN