Provider Demographics
NPI:1235223512
Name:VECCHIO, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:VECCHIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:267 MAECK FARM RD
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6973
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:15 RAYMOND ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1163
Practice Address - Country:US
Practice Address - Phone:315-265-3300
Practice Address - Fax:315-261-4498
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0007616207RG0100X
NY147889207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01042933Medicaid
VT0009153Medicaid
B85524Medicare UPIN
VT0009153Medicaid