Provider Demographics
NPI:1568547446
Name:VENTRILLA, JAMES JOSEPH (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:VENTRILLA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1225 HUFFMAN MILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-8700
Mailing Address - Country:US
Mailing Address - Phone:336-586-0060
Mailing Address - Fax:336-586-0058
Practice Address - Street 1:1225 HUFFMAN MILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-8700
Practice Address - Country:US
Practice Address - Phone:336-586-0060
Practice Address - Fax:336-586-0058
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC101704363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ11960Medicare UPIN
NC2760597AMedicare ID - Type Unspecified