Provider Demographics
NPI:1912961723
Name:VARGO, DAVID JAMES SR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAMES
Last Name:VARGO
Suffix:SR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2000
Mailing Address - Street 2:
Mailing Address - City:EAST SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13057-4500
Mailing Address - Country:US
Mailing Address - Phone:315-446-0033
Mailing Address - Fax:315-362-5284
Practice Address - Street 1:4900 BROAD RD
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-2265
Practice Address - Country:US
Practice Address - Phone:609-581-5303
Practice Address - Fax:609-631-6839
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PARN352802L367500000X
NJ26N010983200367500000X
NY649073367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ089959T9AMedicare PIN