MEDICARE: ALICIA J. SKINNER RPA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	010678	NY

General Provider Information

NPI Number	:	1437150638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICIA J. SKINNER RPA-C

Provider Business Mailing Address
First Line	:	20 PROSPECT ST
Second Line	:	SUITE 106
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1367
Country	:	US
Telephone Number	:	518-885-3755
Fax Number	:	518-885-4613

Provider Business Practice Location Address
First Line	:	20 PROSPECT ST
Second Line	:	SUITE 106
City	:	BALLSTON SPA
State	:	NY
Zip	:	12020-1367
Country	:	US
Telephone Number	:	518-885-3755
Fax Number	:	518-885-4613

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/03/2010

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