Provider Demographics
NPI:1609810431
Name:VANGSNESS, IRENE MARGARET (PA)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:MARGARET
Last Name:VANGSNESS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 TURNHAM CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2619
Mailing Address - Country:US
Mailing Address - Phone:301-838-1991
Mailing Address - Fax:301-947-9513
Practice Address - Street 1:803 RUSSELL AVE
Practice Address - Street 2:SUITE # 1 SMC
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3584
Practice Address - Country:US
Practice Address - Phone:301-869-0700
Practice Address - Fax:301-947-9513
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000827363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0000827OtherMARYLAND CERT #
MD1011307OtherNCCPA CERT#