Provider Demographics
NPI:1861247603
Name:VANADIA, MARIA (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:VANADIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 DOUGLAS TER APT 601
Mailing Address - Street 2:
Mailing Address - City:NORTH PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904-3446
Mailing Address - Country:US
Mailing Address - Phone:207-299-5811
Mailing Address - Fax:
Practice Address - Street 1:15 DOUGLAS TER APT 601
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904-3446
Practice Address - Country:US
Practice Address - Phone:207-299-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-23
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical