Healthcare Provider Details

I. General information

NPI: 1679576797
Provider Name (Legal Business Name): GEORGE J VILUSHIS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PEACH ST
ERIE PA
16508-2776
US

IV. Provider business mailing address

11279 PERRY HWY STE 450
WEXFORD PA
15090-9303
US

V. Phone/Fax

Practice location:
  • Phone: 814-868-9633
  • Fax: 814-866-1436
Mailing address:
  • Phone: 724-933-1100
  • Fax: 724-933-1160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS003551L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: