Provider Demographics
NPI:1841397817
Name:VOGT, PAMELA AMERIGE (ANP)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:AMERIGE
Last Name:VOGT
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-0429
Mailing Address - Country:US
Mailing Address - Phone:845-333-3434
Mailing Address - Fax:845-333-3365
Practice Address - Street 1:707 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2650
Practice Address - Country:US
Practice Address - Phone:845-333-3434
Practice Address - Fax:845-333-3365
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF304249363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q61343Medicare UPIN
NYP00669326Medicare PIN