Healthcare Provider Details

I. General information

NPI: 1841597333
Provider Name (Legal Business Name): ADAM T ROWE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 01/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

IV. Provider business mailing address

77 W BARNEY ST
GOUVERNEUR NY
13642-1040
US

V. Phone/Fax

Practice location:
  • Phone: 315-287-1000
  • Fax: 315-535-9202
Mailing address:
  • Phone: 315-287-1000
  • Fax: 315-535-9202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50-003239
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: