Individual
DYLAN ROBERT VENDRYES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
123 SUMMER ST, WORCESTER, MA 01608-1216
(508) 363-5000
Mailing address
20 WASHINGTON SQ, WORCESTER, MA 01604-4013
(508) 363-5373
(508) 363-7157
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA5640
MA
363AM0700X
Medical Physician Assistant
Primary
PA5640
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1442973
DPH CONTROL NUMBER
MA
01
—
PA5640
DPH LICENSE NUMBER
MA
Enumeration date
03/28/2016
Last updated
11/20/2020
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