Provider Demographics
NPI:1427166883
Name:MAY, DOREEN T (RPA-C)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:T
Last Name:MAY
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 HUDSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12037-1324
Mailing Address - Country:US
Mailing Address - Phone:518-392-6742
Mailing Address - Fax:518-392-6019
Practice Address - Street 1:113 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:NY
Practice Address - Zip Code:12037-1324
Practice Address - Country:US
Practice Address - Phone:518-392-6742
Practice Address - Fax:518-392-6019
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003833363A00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000405581001OtherBSNENY
NY02212366Medicaid
NYAA0422OtherMEDICARE PTAN
NYW34181OtherMEDICARE PTAN
NY070418000033OtherFIDELIS
NY356364OtherMVP HEALTHCARE
NYBA0876OtherMEDICARE PTAN
NYBA0876OtherMEDICARE PTAN
NY000405581001OtherBSNENY
NYJ400158473Medicare PIN