Healthcare Provider Details

I. General information

NPI: 1831319458
Provider Name (Legal Business Name): GLORIA FUINA DARRAH RPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 BRYANT'S COUNTRY SQUARE
GREENVILLE NY
12083
US

IV. Provider business mailing address

20 BRYANT'S COUNTRY SQUARE
GREENVILLE NY
12083
US

V. Phone/Fax

Practice location:
  • Phone: 518-966-8786
  • Fax: 518-966-8787
Mailing address:
  • Phone: 518-966-8786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GLORIA FUINA- DARRAH
Title or Position: OWNER
Credential: RPA
Phone: 518-966-8786