IndividualActive
Bang to, PHYSICIAN ASSISTANT
NPI 1194019935 · Medical Physician Assistant · Winooski, VT
Provider details
- NPI number
- 1194019935
- Entity type
- Individual
- Primary specialty
- Medical Physician AssistantPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- PHYSICIAN ASSISTANT
- Sex
- Male
- Sole proprietor
- No
- License
- 014738 (NY)
Practice location
32 Malletts Bay Avenue
B
Winooski, VT 05404-1959
Phone: (802) 655-4422
Mailing address
32 Malletts Bay Ave
Winooski, VT 05404-1960
Registry dates
- Enumerated
- 2011-06-08
- Last updated
- 2025-08-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.