Provider Demographics
NPI:1447248067
Name:LANCTOT, BETH A (PA-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:LANCTOT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 PRE EMPTION RD
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-2069
Mailing Address - Country:US
Mailing Address - Phone:315-781-2000
Mailing Address - Fax:
Practice Address - Street 1:789 PRE EMPTION RD
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-2069
Practice Address - Country:US
Practice Address - Phone:315-781-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-07
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10000525363AM0700X, 363A00000X
IN10000525A363A00000X
FLPA9102637363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP00924298OtherRAILROAD MEDICARE PTAN
P37659Medicare UPIN
IN677730001Medicare PIN
FLU1924WMedicare ID - Type Unspecified
INP00924298OtherRAILROAD MEDICARE PTAN