1750369856 NPI number — DR. FRANK T VERTOSICK MD

Table of content: DR. FRANK T VERTOSICK MD (NPI 1750369856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750369856 NPI number — DR. FRANK T VERTOSICK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VERTOSICK
Provider First Name:
FRANK
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750369856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
380 W CHESTNUT ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15301-4657
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-228-1414
Provider Business Mailing Address Fax Number:
724-228-8579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
380 W CHESTNUT ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15301-4657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-228-1414
Provider Business Practice Location Address Fax Number:
724-228-8579
Provider Enumeration Date:
01/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  MD027716E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0089167000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0217205 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0011277390012 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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