Provider Demographics
NPI:1952062200
Name:WILLIAMS, VANCAS DEANGELO (PA)
Entity Type:Individual
Prefix:MR
First Name:VANCAS
Middle Name:DEANGELO
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:590 RADIO HILL RD UNIT G
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4465
Mailing Address - Country:US
Mailing Address - Phone:951-261-4884
Mailing Address - Fax:
Practice Address - Street 1:601 RADIO HILL RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4219
Practice Address - Country:US
Practice Address - Phone:276-781-2090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2023-01-26
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant