Basic Information
| Provider Information | |||||||||
| NPI: | 1750380960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VANDUZER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | LEWIS | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167353060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148374560 | ||||||||
| FaxNumber: | 8148377905 | ||||||||
| Practice Location | |||||||||
| Address1: | 4372 ROUTE 6 | ||||||||
| Address2: | |||||||||
| City: | KANE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 167353060 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8148374560 | ||||||||
| FaxNumber: | 8148377905 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 07/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MA001700L | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 363AM0700X | 004581 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | MA001700L | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.