Provider Demographics
NPI:1942286745
Name:MAYER, BRIDGET M (PA)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:M
Last Name:MAYER
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:1001 W FAYETTE ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-2859
Mailing Address - Country:US
Mailing Address - Phone:315-682-6600
Mailing Address - Fax:315-682-0570
Practice Address - Street 1:4500 PEWTER LN
Practice Address - Street 2:BUILDING 1
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9707
Practice Address - Country:US
Practice Address - Phone:315-682-6600
Practice Address - Fax:315-682-0570
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2017-01-26
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Provider Licenses
StateLicense IDTaxonomies
NY003701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02054488Medicaid
CC0964Medicare ID - Type Unspecified
NY02054488Medicaid
P03202Medicare UPIN