Individual
JONATHAN VANDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
60 FENWOOD RD FL 2, BOSTON, MA 02115-6128
(617) 732-5322
Mailing address
831 E 2ND ST # 2, SOUTH BOSTON, MA 02127-2333
(413) 262-9376
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
PA6762
MA
Other
Enumeration date
09/25/2018
Last updated
09/25/2018
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