Provider Demographics
NPI:1174591796
Name:DAY, W MARVIN (PA)
Entity type:Individual
Prefix:
First Name:W
Middle Name:MARVIN
Last Name:DAY
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:100 PARK STREET
Mailing Address - Street 2:GLENS FALLS HOSPITAL - CREDENTIALING
Mailing Address - City:GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12801-4413
Mailing Address - Country:US
Mailing Address - Phone:518-926-5924
Mailing Address - Fax:518-926-6983
Practice Address - Street 1:79 NORTH ST
Practice Address - Street 2:GRANVILLE FAMILY HEALTH
Practice Address - City:GRANVILLE
Practice Address - State:NY
Practice Address - Zip Code:12832-1137
Practice Address - Country:US
Practice Address - Phone:518-642-0612
Practice Address - Fax:518-642-0693
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-02-10
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Provider Licenses
StateLicense IDTaxonomies
NY005618-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00466854OtherRR MEDICARE
S63240Medicare UPIN
NYPA2245Medicare PIN
NYP00466854OtherRR MEDICARE