Healthcare Provider Details

I. General information

NPI: 1033205364
Provider Name (Legal Business Name): BARBARA A FLUTY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 COLLEGE HILL RD
CLINTON NY
13323-1218
US

IV. Provider business mailing address

198 COLLEGE HILL RD
CLINTON NY
13323-1218
US

V. Phone/Fax

Practice location:
  • Phone: 315-859-4111
  • Fax: 315-859-4963
Mailing address:
  • Phone: 315-859-4111
  • Fax: 315-859-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number005658
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: