Provider Demographics
NPI:1518491984
Name:VANDERBURG, AARON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AARON
Middle Name:
Last Name:VANDERBURG
Suffix:
Gender:M
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:HHB 2-1 ADA BN
Mailing Address - Street 2:UNIT 15754 BOX #492
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96260
Mailing Address - Country:US
Mailing Address - Phone:315-737-4246
Mailing Address - Fax:
Practice Address - Street 1:BLDG S180 AMERICAN AVE
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96260
Practice Address - Country:US
Practice Address - Phone:315-737-4246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138826363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant