Provider Demographics
NPI:1992131973
Name:PADDOCK, ADAM W (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:W
Last Name:PADDOCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4000 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-6631
Mailing Address - Country:US
Mailing Address - Phone:315-663-0100
Mailing Address - Fax:315-663-0052
Practice Address - Street 1:4000 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-6631
Practice Address - Country:US
Practice Address - Phone:315-663-0100
Practice Address - Fax:315-663-0052
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY017022363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant