Provider Demographics
NPI:1972945541
Name:DUBOIS, MARLYSS BARTON (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARLYSS
Middle Name:BARTON
Last Name:DUBOIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARLYSS
Other - Middle Name:B
Other - Last Name:DARROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:134 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045-1206
Mailing Address - Country:US
Mailing Address - Phone:607-758-8019
Mailing Address - Fax:607-758-8210
Practice Address - Street 1:134 HOMER AVE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-1206
Practice Address - Country:US
Practice Address - Phone:607-756-3561
Practice Address - Fax:607-428-5142
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016687363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400090289/GP 70008AMedicare PIN
NYJ400090291/GP BA0017Medicare PIN