Individual provider · Type 1 NPI

Bobbie Rae Faivus Vangorder, P.A.

Medical Physician Assistant · Oswego, NY

NPI number 1154630366 Active

Practice location

110 W Utica St
Oswego, NY 13126-3047

Mailing address

110 W 6th St
Oswego, NY 13126-2507

Other practice locations

  • 1 College Plaza, Oswego, NY 13126-1731 · (315) 342-0030

Specialties and licenses

TaxonomyCodeLicense
Medical Physician Assistant Primary 363AM0700X014226 (NY)

Medical Physician Assistant: Definition to come...

12 other providers at this address

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About NPI 1154630366

Bobbie Rae Faivus Vangorder, P.A.'s National Provider Identifier is 1154630366, issued on Oct 5, 2010. The primary taxonomy on file is Medical Physician Assistant (363AM0700X), and the practice location is in Oswego, NY. The record was last updated on Mar 29, 2023.