1831185289 NPI number — DR. CHRISTOPHER P VAGLIA MD

Table of content: DR. CHRISTOPHER P VAGLIA MD (NPI 1831185289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831185289 NPI number — DR. CHRISTOPHER P VAGLIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VAGLIA
Provider First Name:
CHRISTOPHER
Provider Middle Name:
P
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:
1831185289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 S 8TH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
INDIANA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15701-2776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-463-0476
Provider Business Mailing Address Fax Number:
724-463-1196

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 COLONY BLVD
Provider Second Line Business Practice Location Address:
STE 108
Provider Business Practice Location Address City Name:
BLAIRSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15717-1357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-459-6063
Provider Business Practice Location Address Fax Number:
724-459-6022
Provider Enumeration Date:
09/21/2005

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: 208000000X , with the licence number:  MD073345L , 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: 101107640001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 848902 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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