MEDICARE: CHRISTIE FLANAGAN PA

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	018876	NY

General Provider Information

NPI Number	:	1730565219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIE FLANAGAN PA

Provider Business Mailing Address
First Line	:	700 S PERRY ST
Second Line	:	JOHNSTOWN HEALTH CENTER
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3213
Country	:	US
Telephone Number	:	518-762-3161
Fax Number	:	518-762-4902

Provider Business Practice Location Address
First Line	:	700 S PERRY ST
Second Line	:	JOHNSTOWN HEALTH CENTER
City	:	JOHNSTOWN
State	:	NY
Zip	:	12095-3213
Country	:	US
Telephone Number	:	518-762-3161
Fax Number	:	518-762-4902

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

Provider Enumeration Date	:	08/06/2015
Last Update Date	:	08/06/2015

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