Provider Demographics
NPI:1821109992
Name:HILDRETH, DEBORAH ANN (RPA-C)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:HILDRETH
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:POMAKOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:711 TROY SCHENECTADY RD STE 203
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2461
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:3305 ROUTE 43
Practice Address - Street 2:
Practice Address - City:AVERILL PARK
Practice Address - State:NY
Practice Address - Zip Code:12413
Practice Address - Country:US
Practice Address - Phone:518-674-5797
Practice Address - Fax:518-674-2396
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005707363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02706072Medicaid
NY000415298001OtherBSNENY
NY070418000037OtherFIDELIS
NY02706072Medicaid
NY02706072Medicaid
NYQ53936Medicare UPIN