Basic Information
| Provider Information | |||||||||
| NPI: | 1174165492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUFT | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | KATHERINE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ATWELL ROAD | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075476936 | ||||||||
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| Practice Location | |||||||||
| Address1: | 170 BURWELL STREET | ||||||||
| Address2: | |||||||||
| City: | LITTLE FALLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 13365 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158234546 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/09/2019 | ||||||||
| LastUpdateDate: | 10/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 024047-01 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.