Provider Demographics
NPI:1750380960
Name:VANDUZER, WILLIAM LEWIS (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LEWIS
Last Name:VANDUZER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4372 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-3060
Mailing Address - Country:US
Mailing Address - Phone:814-837-4560
Mailing Address - Fax:814-837-7905
Practice Address - Street 1:4372 ROUTE 6
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-3060
Practice Address - Country:US
Practice Address - Phone:814-837-4560
Practice Address - Fax:814-837-7905
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA001700L207P00000X, 363AM0700X
NY004581363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P34908Medicare UPIN
NYCC6430Medicare PIN
NYCC6426Medicare PIN
NYCC6428Medicare PIN
NYCC6425Medicare PIN
NYCC6227Medicare PIN
NYCC6424Medicare PIN
NYCC6422Medicare PIN
NYPA2182Medicare PIN
PA079998Medicare PIN