Provider Demographics
NPI:1922090208
Name:VICK, DANA JAMES (MD, MBA, CPE)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:JAMES
Last Name:VICK
Suffix:
Gender:M
Credentials:MD, MBA, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:NY
Mailing Address - Zip Code:13421-2611
Mailing Address - Country:US
Mailing Address - Phone:315-361-2409
Mailing Address - Fax:315-361-2391
Practice Address - Street 1:321 GENESEE ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2611
Practice Address - Country:US
Practice Address - Phone:315-361-2409
Practice Address - Fax:315-361-2391
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY228315207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02462802Medicaid
NY02462802Medicaid
DD5851Medicare PIN
H85502Medicare UPIN