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General NPI Number Information
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NPI Number | 1689191736
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Entity Type | Individual
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Provider Name | EMILY M MARRIS PA
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Gender | Female
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Dates
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Enumeration Date | 08/29/2017
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Last Update Date | 08/29/2017
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Provider Practice Location Address
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Address Line | 4103 MEDICAL CENTER DR
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City | FAYETTEVILLE
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State | NY
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Zip | 13066-6600
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Country | US
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Telephone | 315-744-1500
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Fax | 315-637-7808
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Provider Business Mailing Address
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Address Line | 301 PROSPECT AVE RM 1605
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City | SYRACUSE
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State | NY
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Zip | 13203-1807
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Country | US
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Telephone | 315-744-1819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State | NY
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