MEDICARE: KENNA ELMENDORF-BURNS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	003381	NY

General Provider Information

NPI Number	:	1043264344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNA ELMENDORF-BURNS PA-C

Provider Business Mailing Address
First Line	:	1 PINNACLE PLACE
Second Line	:	SUITE 102
City	:	ALBANY
State	:	NY
Zip	:	12203
Country	:	US
Telephone Number	:	518-689-0244
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PINNACLE PL
Second Line	:	SUITE 102
City	:	ALBANY
State	:	NY
Zip	:	12203-3496
Country	:	US
Telephone Number	:	518-689-0244
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/20/2006
Last Update Date	:	06/06/2017

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