Individual
BLYTHE E FAWCETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
37 W GARDEN ST STE 105, AUBURN, NY 13021
(315) 252-0000
(315) 252-0070
Mailing address
17 LANSING ST, AUBURN, NY 13021-1983
(315) 567-0455
(315) 253-1795
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
009708
NY
363AS0400X
Surgical Physician Assistant
009708
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03444915
—
NY
Enumeration date
02/08/2007
Last updated
08/08/2018
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