MRS. BOBBIE RAE FAIVUS VANGORDER (NPI# 1154630366) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1154630366 |
Entity Type | Individual |
Full Name | MRS. BOBBIE RAE FAIVUS VANGORDER |
Credential | P.A. |
Practice Address |
110 W Utica St Oswego NY 13126-3047 |
Mailing Address |
1 College Plaza Oswego NY 13126-1731 |
Practice Telephone | 3153495537 |
Mailing Telephone | 3153420030 |
Mailing Fax Number | 3153420258 |
Enumeration Date | 2010-10-05 |
Last Update Date | 2020-09-11 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AM0700X |
Physician Assistant Specialization: Medical |
014226 | NY | Physician Assistants & Advanced Practice Nursing Providers |
Address | Telephone Number | Fax Number |
---|---|---|
1 College Plaza, Oswego, NY 131261731 | 3153420030 | 3153420258 |
Street Address |
110 W UTICA ST |
City | OSWEGO |
State | NY |
Zip Code | 13126-3047 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1740247493 | Jessica Marie Digby | Physician Assistant | 110 W Utica St, Oswego, NY 13126-3047 | 2006-04-27 |
1629489588 | Oswego Family Physicians PC | Non-Pharmacy Dispensing Site | 110 W Utica St, Oswego, NY 13126-3047 | 2014-05-14 |
1659450989 | Douglas Paul Guenter | Emergency Medicine | 110 W Utica St, Oswego, NY 13126-3047 | 2006-11-06 |
1477567493 | Robert F Schaefer Jr. | Dentist | 110 W Utica St, Oswego, NY 13126-3047 | 2006-07-27 |
1831126648 | Mark Anthony Humphrey | Family Medicine | 110 W Utica St, Oswego, NY 13126-3057 | 2006-06-27 |
1891721957 | Robert Charles Morgan | Family Medicine | 110 W Utica St, Oswego, NY 13126-3057 | 2006-06-23 |
1659317980 | Micheal D Stephens | Family Medicine | 110 W Utica St, Oswego, NY 13126-3057 | 2006-06-22 |
1477506996 | Oswego Family Physicians, PC | Medical Genetics, Ph.D. Medical Genetics | 110 W Utica St, Oswego, NY 13126-3057 | 2006-05-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992303572 | Elise Fitzsimmons | Specialist/Technologist | 9 Laker Hall, Oswego, NY 13126 | 2020-10-15 |
1023651742 | Jessica Lynn Metzger | Physician Assistant | 300 Ny-104 Suite 1, Oswego, NY 13126 | 2019-10-25 |
1245887009 | Maureen Adams | Technician | 30 Stone Ridge Drive, Oswego, NY 13126 | 2019-08-26 |
1285128314 | Justin Raymond Beebe | Nurse Practitioner | 300 State Route 104 Ste 2, Oswego, NY 13126 | 2018-06-21 |
1801311220 | Lynne M Wallace | Registered Nurse | 29 Birch Lane 17b, Oswego, NY 13126 | 2017-08-07 |
1497203962 | Lindsay Cheslock | Local Education Agency (LEA) | 529 County Route 25, Oswego, NY 13126 | 2016-09-14 |
1942757919 | Aimee Devinny | Registered Nurse | 21 Twin Orchard Drive, Oswego, NY 13126 | 2016-09-07 |
1083160295 | Cameron Delmotte | Specialist | 159 West Frist Street, Oswego, NY 13126 | 2016-08-28 |
1508319187 | Samantha Thayer | Occupational Therapist | 159 West First Oswego St, Oswego, NY 13126 | 2016-07-29 |
1104279595 | Vikram Jala | Internal Medicine | 105 County Route 45a Ste 400, Oswego, NY 13126 | 2016-07-20 |
Find all providers in zip 13126 |
Taxonomy Code | 363AM0700X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Medical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023651742 | Jessica Lynn Metzger | Physician Assistant | 300 Ny-104 Suite 1, Oswego, NY 13126 | 2019-10-25 |
1063072973 | John Riley Clark | Physician Assistant | 2700 Light Rd Apt 102, Oswego, IL 60543-9231 | 2019-06-13 |
1114476231 | Emily Crandell | Physician Assistant | 300 State Route 104, Oswego, NY 13126-2956 | 2016-09-30 |
1457477499 | Curtis Charles Lieber | Physician Assistant | 10 George St, Oswego, NY 13126-3276 | 2007-03-21 |
1144320862 | Alexander James Brown | Physician Assistant | 110 W 6th St, Oswego, NY 13126-2507 | 2006-09-23 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1487252581 | North Shore Medical Group Pllc | Physician Assistant | 311 Skyview Ter, Syracuse, NY 13219-2835 | 2020-10-12 |
1477169654 | Kristen Ariel O'connell | Physician Assistant | 85 John St Apt 7a, New York, NY 10038-2844 | 2020-09-22 |
1699381616 | David Nmn Kao | Physician Assistant | 737 Pleasant Avenue, Westbury, NY 11590-6407 | 2020-09-16 |
1043824816 | Elizabeth Keane | Physician Assistant | 25 Hollis Dr, Sound Beach, NY 11789-1629 | 2020-08-31 |
1497364111 | Tianna Stephens | Physician Assistant | 165 N Village Ave Ste 5, Rockville Centre, NY 11570-3701 | 2020-07-28 |
1124636188 | Shannon Maureen O'connell | Physician Assistant | 270-05 270th Ave, New Hyde Park, NY 11040 | 2020-07-16 |
1841818895 | Yanick Dugue | Physician Assistant | 4 Lincoln Ave, New Hyde Park, NY 11040-3125 | 2020-07-07 |
1194340505 | Kayleigh Marie Tourt | Physician Assistant | 222 Alexander St Fl 4, Rochester, NY 14607-4039 | 2020-06-11 |
1023638509 | Kristina Rajic | Physician Assistant | 7237 66th Dr, Flushing, NY 11379-2111 | 2020-04-24 |
1114547791 | Michele Hein | Physician Assistant | 700 Veterans Memorial Hwy, Hauppauge, NY 11788-2952 | 2020-04-23 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.