MEDICARE: DANA VUCINICH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD-043048-L	PA
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	MD043048L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	022101	OTHER	PA	BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356351290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA VUCINICH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 14397
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-7397
Country	:	US
Telephone Number	:	330-758-2775
Fax Number	:	330-758-2787

Provider Business Practice Location Address
First Line	:	1000 S MERCER ST
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-4672
Country	:	US
Telephone Number	:	330-758-2775
Fax Number	:	330-758-2787

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	05/19/2014

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