Provider Demographics
NPI:1962483172
Name:BOSS, DONNA JEAN (PA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JEAN
Last Name:BOSS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 304
Mailing Address - Street 2:
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801
Mailing Address - Country:US
Mailing Address - Phone:518-926-6620
Mailing Address - Fax:518-926-1954
Practice Address - Street 1:102 PARK ST
Practice Address - Street 2:CR WOOD CANCER CENTER
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4403
Practice Address - Country:US
Practice Address - Phone:518-926-6620
Practice Address - Fax:518-926-1954
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2012-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY002440363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00007864OtherRR MEDICARE
NY01280304Medicaid
NYP00007864OtherRR MEDICARE
P23742Medicare UPIN