Healthcare Provider Details

I. General information

NPI: 1740681238
Provider Name (Legal Business Name): MARJORIE GRACE DAVID PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARJORIE FISHER

II. Dates (important events)

Enumeration Date: 09/16/2014
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8411 SENECA TPKE
NEW HARTFORD NY
13413-4912
US

IV. Provider business mailing address

2209 GENESEE ST-BUSINESS OFFICE ROOM 310
UTICA NY
13501-5930
US

V. Phone/Fax

Practice location:
  • Phone: 315-624-8500
  • Fax: 315-624-8515
Mailing address:
  • Phone: 315-801-3282
  • Fax: 315-801-8391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: