Provider Demographics
NPI:1801235288
Name:DESMARAIS, VANESSA (MD)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DESMARAIS
Suffix:
Gender:F
Credentials:MD
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 277
Mailing Address - Street 2:75 PARK STREET
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:12932-0277
Mailing Address - Country:US
Mailing Address - Phone:518-895-4050
Mailing Address - Fax:
Practice Address - Street 1:66 PARK STREET
Practice Address - Street 2:ELIZABETHTROWN HEALTH CENTER
Practice Address - City:ELIZABETHTOWN
Practice Address - State:NY
Practice Address - Zip Code:12932-0277
Practice Address - Country:US
Practice Address - Phone:518-895-4050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-19
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY282357207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine