Provider Demographics
NPI:1952392904
Name:VECCHIO, PAULA (MD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VECCHIO
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 1:5 ANN ST
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:NY
Mailing Address - Zip Code:13407-1103
Mailing Address - Country:US
Mailing Address - Phone:315-866-0040
Mailing Address - Fax:315-866-1939
Practice Address - Street 1:6 HAMPDEN PL
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5631
Practice Address - Country:US
Practice Address - Phone:315-733-2526
Practice Address - Fax:315-733-2846
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY156508-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01114483Medicaid
NYY70151Medicare ID - Type UnspecifiedMEDICARE
NY01114483Medicaid