Provider Demographics
NPI:1942471255
Name:HARPER, ANN-MARIE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANN-MARIE
Middle Name:
Last Name:HARPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ANN-MARIE
Other - Middle Name:
Other - Last Name:GADOMSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5100 W TAFT RD
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-3807
Mailing Address - Country:US
Mailing Address - Phone:315-452-2333
Mailing Address - Fax:315-452-2336
Practice Address - Street 1:5100 W TAFT RD
Practice Address - Street 2:SUITE 1C
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-3807
Practice Address - Country:US
Practice Address - Phone:315-452-2333
Practice Address - Fax:315-452-2336
Is Sole Proprietor?:No
Enumeration Date:2008-03-13
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23011646363AM0700X
NC0010-01804363AM0700X
NY011646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03496980Medicaid
NYJ400082744Medicare PIN