Provider Demographics
NPI:1932252756
Name:GAVIN, THOMAS (RPA)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GAVIN
Suffix:
Gender:M
Credentials:RPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 COOLIDGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:DIAMOND POINT
Mailing Address - State:NY
Mailing Address - Zip Code:12824-2011
Mailing Address - Country:US
Mailing Address - Phone:518-578-1703
Mailing Address - Fax:
Practice Address - Street 1:675 STATE ROUTE 3
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-6562
Practice Address - Country:US
Practice Address - Phone:518-566-0672
Practice Address - Fax:518-566-0641
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005798363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical