Basic Information
| Provider Information | |||||||||
| NPI: | 1598743189 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VOZZELLA | ||||||||
| FirstName: | ANGELO | ||||||||
| MiddleName: | CHARLES | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 173 MIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035843508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037885029 | ||||||||
| FaxNumber: | 6037885607 | ||||||||
| Practice Location | |||||||||
| Address1: | 173 MIDDLE ST | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | NH | ||||||||
| PostalCode: | 035843508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6037885095 | ||||||||
| FaxNumber: | 6037885092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/04/2006 | ||||||||
| LastUpdateDate: | 08/23/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/23/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 0270 | NH | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 30330730 | 05 | NH | MEDICAID | 1008489 | 05 | VT | MEDICAID | 3073179 | 05 | NH | MEDICAID |