Provider Demographics
NPI:1538228473
Name:WHITTOCK, ANDREW J (RPA-C)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:WHITTOCK
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Gender:M
Credentials:RPA-C
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Mailing Address - Street 1:200 FRONT STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-1559
Mailing Address - Country:US
Mailing Address - Phone:607-748-9001
Mailing Address - Fax:607-748-8546
Practice Address - Street 1:200 FRONT STREET
Practice Address - Street 2:SUITE A
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1559
Practice Address - Country:US
Practice Address - Phone:607-748-9001
Practice Address - Fax:607-748-8546
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY006230-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical