Healthcare Provider Details

I. General information

NPI: 1114926979
Provider Name (Legal Business Name): PATRICIA NICHOLETTE VIGDER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 CONSTITUTION BLVD UPPER LEVEL
BEAVER FALLS PA
15010-1278
US

IV. Provider business mailing address

2620 CONSTITUTION BLVD UPPER LEVEL
BEAVER FALLS PA
15010-1278
US

V. Phone/Fax

Practice location:
  • Phone: 724-843-0737
  • Fax: 724-770-7922
Mailing address:
  • Phone: 724-843-0737
  • Fax: 724-770-7922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number34-00-7995-V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: