Healthcare Provider Details

I. General information

NPI: 1629547518
Provider Name (Legal Business Name): KELSEY HOAR PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2018
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1769 UNION ST
NISKAYUNA NY
12309-6311
US

IV. Provider business mailing address

115 SARATOGA RD STE 110
GLENVILLE NY
12302-4210
US

V. Phone/Fax

Practice location:
  • Phone: 518-264-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number055-0031489
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number023021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: