Provider Demographics
NPI:1912985714
Name:VANNIEL, DAVID (PA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:VANNIEL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 919
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5528
Mailing Address - Country:US
Mailing Address - Phone:860-524-5905
Mailing Address - Fax:860-522-3951
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 725 CONNECTICUT CARDIOTHORACIC SURGICAL ASSOC
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106
Practice Address - Country:US
Practice Address - Phone:860-524-5905
Practice Address - Fax:860-522-3951
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2019-06-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT000357363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S95958Medicare UPIN
CTD400044544Medicare PIN
CT970000122Medicare ID - Type Unspecified