1902892813 NPI number — PRAKASH K VIN MD

Table of content: COLLETTE FAUCHER SANDLER FNP-BC (NPI 1295076941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902892813 NPI number — PRAKASH K VIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIN
Provider First Name:
PRAKASH
Provider Middle Name:
K
Provider Name Prefix Text:
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:
1902892813
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 215
Provider Second Line Business Mailing Address:
118 W FOURTH AVE
Provider Business Mailing Address City Name:
DERRY
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15627-0215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-694-2765
Provider Business Mailing Address Fax Number:
724-694-2870

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 W 4TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DERRY
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15627-1252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-694-2765
Provider Business Practice Location Address Fax Number:
724-694-2870
Provider Enumeration Date:
09/26/2005

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: 207R00000X , with the licence number:  MD037361L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0100X , with the licence number: MD037361L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 11440 . This is a "HEALTH AM HEALTHASSUR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 060480 . This is a "THREE RIVERS HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000626144 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1016662 . This is a "GATEWAY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112076401 . This is a "UPMC FOR YOU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 77498 . This is a "USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 154859 . This is a "HIGHMARK PRODUCTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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