Healthcare Provider Details

I. General information

NPI: 1821335704
Provider Name (Legal Business Name): ALEXANDRIA M COBB RPA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRIA M BANN PA

II. Dates (important events)

Enumeration Date: 01/11/2013
Last Update Date: 03/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5008 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057
US

IV. Provider business mailing address

5008 BRITTONFIELD PKWY
EAST SYRACUSE NY
13057-9248
US

V. Phone/Fax

Practice location:
  • Phone: 315-472-7504
  • Fax: 315-634-4677
Mailing address:
  • Phone: 315-472-7504
  • Fax: 315-634-4677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number016333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: