Provider Demographics
NPI:1891902029
Name:KOKKINIDES, PAUL (RPA-C)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:KOKKINIDES
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5509
Mailing Address - Country:US
Mailing Address - Phone:518-583-4268
Mailing Address - Fax:518-581-1636
Practice Address - Street 1:520 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5509
Practice Address - Country:US
Practice Address - Phone:518-583-4268
Practice Address - Fax:518-581-1636
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant