Provider Demographics
NPI:1598737801
Name:VANDERWEELE, JON ROBERT (DO)
Entity type:Individual
Prefix:
First Name:JON
Middle Name:ROBERT
Last Name:VANDERWEELE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W 6TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-2554
Mailing Address - Country:US
Mailing Address - Phone:315-349-5828
Mailing Address - Fax:315-349-5829
Practice Address - Street 1:140 W 6TH ST
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2525
Practice Address - Country:US
Practice Address - Phone:315-349-5826
Practice Address - Fax:315-349-5829
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY296514-01207Y00000X
VA01022017682083P0011X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN