Provider Demographics
NPI:1548917230
Name:PURCELL, TROY ANTHONY (PA-C)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:ANTHONY
Last Name:PURCELL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8594 DICOB RD
Mailing Address - Street 2:
Mailing Address - City:CROGHAN
Mailing Address - State:NY
Mailing Address - Zip Code:13327-1810
Mailing Address - Country:US
Mailing Address - Phone:315-679-6662
Mailing Address - Fax:
Practice Address - Street 1:1419 SALT SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13214-1301
Practice Address - Country:US
Practice Address - Phone:315-445-4100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program