Provider Demographics
NPI:1154721546
Name:VANNESS, JAMES DAVID (PA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:DAVID
Last Name:VANNESS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:439 STATE ROUTE 22B
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:NY
Mailing Address - Zip Code:12972-5423
Mailing Address - Country:US
Mailing Address - Phone:518-643-0072
Mailing Address - Fax:
Practice Address - Street 1:8 BROAD ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-3420
Practice Address - Country:US
Practice Address - Phone:518-825-1555
Practice Address - Fax:518-825-1550
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2023-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0177991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant