Provider Demographics
NPI:1811549165
Name:BITAR, MARIE (PA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:
Last Name:BITAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:
Other - Last Name:KALET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1474
Mailing Address - Country:US
Mailing Address - Phone:518-489-2663
Mailing Address - Fax:518-689-3881
Practice Address - Street 1:5 CARE LN
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-8623
Practice Address - Country:US
Practice Address - Phone:518-489-2663
Practice Address - Fax:518-689-3881
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NY023665363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY023665OtherNY LICENSE
NY06091092Medicaid
NY06091092Medicaid