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Individual

DR. J NICHOLAS VANDEMOER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
49 LAKESIDE DR E, CENTERVILLE, MA 02632-1834
(508) 771-8017
Mailing address
68 CAMP ST, HYANNIS, MA 02601-3048
(508) 775-7026

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
36521
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2021455
MA
Enumeration date
06/05/2007
Last updated
10/27/2019
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