Provider Demographics
NPI:1134873540
Name:BOWER, BELLAME ELISA (PA-C)
Entity type:Individual
Prefix:
First Name:BELLAME
Middle Name:ELISA
Last Name:BOWER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:6 WELLNESS WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110-2156
Mailing Address - Country:US
Mailing Address - Phone:518-782-3700
Mailing Address - Fax:518-782-3799
Practice Address - Street 1:2125 RIVER RD STE 203
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12309-1110
Practice Address - Country:US
Practice Address - Phone:518-831-8530
Practice Address - Fax:518-831-8545
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2024-09-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY029284363A00000X
363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant