MEDICARE: DONNA M PRIME RPA-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	006862-1	NY

General Provider Information

NPI Number	:	1336121516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONNA M PRIME RPA-C

Provider Business Mailing Address
First Line	:	340A MAIN ST
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-1530
Country	:	US
Telephone Number	:	518-747-4117
Fax Number	:	518-747-9837

Provider Business Practice Location Address
First Line	:	340A MAIN ST
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-1530
Country	:	US
Telephone Number	:	518-747-4117
Fax Number	:	518-747-9837

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

Provider Enumeration Date	:	11/15/2005
Last Update Date	:	05/19/2020

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