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NPI Code Detail

MEDICARE: MRS. KELLY A HALCOMB RPA C

MEDICARE: MRS. KELLY A HALCOMB 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
1363A00000XPhysician Assistant010492NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811933856
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY A HALCOMB RPA C
Provider Business Mailing Address
First Line : 4855 CAMP RD
Second Line : SUITE 100
City : HAMBURG
State : NY
Zip : 14075-2600
Country : US
Telephone Number : 716-646-1084
Fax Number : 716-646-0763
Provider Business Practice Location Address
First Line : 4855 CAMP RD
Second Line : SUITE 100
City : HAMBURG
State : NY
Zip : 14075-2600
Country : US
Telephone Number : 716-646-1084
Fax Number : 716-646-0763
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2006
Last Update Date : 07/20/2014

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Directions to “ MRS. KELLY A HALCOMB RPA C” Practice Location

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