Provider Demographics
NPI:1861429995
Name:KNAPP, MARCUS M (PA)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:M
Last Name:KNAPP
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:19320 US ROUTE 11
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5337
Mailing Address - Country:US
Mailing Address - Phone:315-786-0254
Mailing Address - Fax:315-786-0976
Practice Address - Street 1:19320 US ROUTE 11 BLDG III
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-5337
Practice Address - Country:US
Practice Address - Phone:315-786-0254
Practice Address - Fax:315-785-3647
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0090201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02429885Medicaid
NYP70410Medicare UPIN
NY02429885Medicaid