Provider Demographics
NPI:1841256500
Name:SENESE, DAVID M (PA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:SENESE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:66 KNIGHT LN STE 10
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9308
Mailing Address - Country:US
Mailing Address - Phone:802-872-4343
Mailing Address - Fax:802-288-1144
Practice Address - Street 1:9 CREST RD
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-9701
Practice Address - Country:US
Practice Address - Phone:802-527-0753
Practice Address - Fax:802-524-2695
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2019-03-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VT055-0030432363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTAP0383Medicare ID - Type Unspecified
VTS41275Medicare UPIN