Provider Demographics
NPI:1871599720
Name:GAY, KAREN M (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:GAY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ANN
Other - Last Name:MATTOON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:SYRACUSE VAMC
Mailing Address - Street 2:800 IRVING AVENUE
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-425-4400
Mailing Address - Fax:315-425-3447
Practice Address - Street 1:SYRACUSE VAMC
Practice Address - Street 2:800 IRVING AVENUE
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-425-4400
Practice Address - Fax:315-425-3447
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005241-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP35611Medicare UPIN
NYPA0154Medicare ID - Type Unspecified