Provider Demographics
NPI:1205610060
Name:RABIDEAU, ALEXANDER CHRISTIAN (PA)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:CHRISTIAN
Last Name:RABIDEAU
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BOYNTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-1237
Mailing Address - Country:US
Mailing Address - Phone:518-324-3399
Mailing Address - Fax:
Practice Address - Street 1:128 BOYNTON AVE
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1237
Practice Address - Country:US
Practice Address - Phone:518-324-3399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030221363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant