Provider Demographics
NPI:1134212673
Name:DEPAN-CARTIER, GAYLE B (PA)
Entity type:Individual
Prefix:
First Name:GAYLE
Middle Name:B
Last Name:DEPAN-CARTIER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 LEROY ST
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1786
Mailing Address - Country:US
Mailing Address - Phone:315-265-3300
Mailing Address - Fax:315-261-6025
Practice Address - Street 1:35 GILBERT ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-2618
Practice Address - Country:US
Practice Address - Phone:518-677-3961
Practice Address - Fax:518-677-3180
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010404363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid
NYJ400046697Medicare PIN
NYPENDINGMedicaid