Healthcare Provider Details

I. General information

NPI: 1972945541
Provider Name (Legal Business Name): MARLYSS BARTON DUBOIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARLYSS B DARROW PA

II. Dates (important events)

Enumeration Date: 07/24/2013
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 HOMER AVE
CORTLAND NY
13045-1206
US

IV. Provider business mailing address

134 HOMER AVE
CORTLAND NY
13045-1206
US

V. Phone/Fax

Practice location:
  • Phone: 607-756-3561
  • Fax: 607-428-5142
Mailing address:
  • Phone: 607-758-8019
  • Fax: 607-758-8210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number016687
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: