Provider Demographics
NPI:1306186929
Name:VEDAR, POL MARTIN DIMASUHID (PA)
Entity Type:Individual
Prefix:
First Name:POL
Middle Name:MARTIN DIMASUHID
Last Name:VEDAR
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 602658
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2658
Mailing Address - Country:US
Mailing Address - Phone:336-716-2255
Mailing Address - Fax:336-716-3348
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-0001
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-3348
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2024-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC0010-04078363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant