Healthcare Provider Details

I. General information

NPI: 1336066695
Provider Name (Legal Business Name): AIDEN TAM PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 LEROY ST
POTSDAM NY
13676-1799
US

IV. Provider business mailing address

50 LEROY ST
POTSDAM NY
13676-1799
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: