Individual
VANIA MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
USA MEDDAC, 11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-5004
(315) 772-7059
Mailing address
USA MEDDAC, 11050 MT BELVEDERE BLVD, FORT DRUM, NY 13602-5004
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
1164161972
MD
208D00000X
General Practice Physician
Primary
1164161972
MD
Other
Enumeration date
05/31/2022
Last updated
08/13/2025
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