Provider Demographics
NPI:1841327483
Name:ORRIS, VALERIE C (PA)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:C
Last Name:ORRIS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:
Other - Last Name:WHITNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:101 JORDAN RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-8309
Mailing Address - Country:US
Mailing Address - Phone:518-274-1947
Mailing Address - Fax:
Practice Address - Street 1:101 JORDAN RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-8309
Practice Address - Country:US
Practice Address - Phone:518-274-1947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009612363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid
NYPENDINGMedicaid
PENDINGMedicare UPIN