Healthcare Provider Details

I. General information

NPI: 1922090208
Provider Name (Legal Business Name): DANA JAMES VICK M.D., MBA, CPE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 11/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 GENESEE ST
ONEIDA NY
13421-2611
US

IV. Provider business mailing address

321 GENESEE ST
ONEIDA NY
13421-2611
US

V. Phone/Fax

Practice location:
  • Phone: 315-361-2409
  • Fax: 315-361-2391
Mailing address:
  • Phone: 315-361-2409
  • Fax: 315-361-2391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number228315
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: