Provider Demographics
NPI:1801823299
Name:FLAHERTYTHOMPSON, DARREN (NP)
Entity Type:Individual
Prefix:MRS
First Name:DARREN
Middle Name:
Last Name:FLAHERTYTHOMPSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 BRITTONFIELD
Mailing Address - Street 2:SUITE A116
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057
Mailing Address - Country:US
Mailing Address - Phone:315-634-5550
Mailing Address - Fax:315-295-2125
Practice Address - Street 1:5000 BRITTONFIELD PARKWAY
Practice Address - Street 2:SUITE A116
Practice Address - City:EAST SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13057
Practice Address - Country:US
Practice Address - Phone:315-634-5550
Practice Address - Fax:315-634-5553
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302492-1363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB4789Medicare PIN
NYP10656Medicare UPIN
NYCC4347Medicare PIN