Provider Demographics
NPI:1770639247
Name:JAMES, ELYSABETHE A (PA)
Entity Type:Individual
Prefix:MRS
First Name:ELYSABETHE
Middle Name:A
Last Name:JAMES
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 1:265 AVIATION AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-6060
Mailing Address - Country:US
Mailing Address - Phone:855-262-6789
Mailing Address - Fax:855-262-6789
Practice Address - Street 1:265 AVIATION AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-6060
Practice Address - Country:US
Practice Address - Phone:855-262-6789
Practice Address - Fax:855-262-6789
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0550030693363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT043595303OtherTAX ID
VTP20022Medicare UPIN
VTAP1367Medicare ID - Type UnspecifiedMEDICARE ID