Healthcare Provider Details

I. General information

NPI: 1295622843
Provider Name (Legal Business Name): THERESA ROSE EAMER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEROY ST
POTSDAM NY
13676-1786
US

IV. Provider business mailing address

22 BAY ST
POTSDAM NY
13676-2014
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-3300
  • Fax:
Mailing address:
  • Phone: 518-578-4313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number034147
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: