Healthcare Provider Details

I. General information

NPI: 1811962780
Provider Name (Legal Business Name): VINCENT J BOBBY DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 AIRPORT RD
HAZLE TOWNSHIP PA
18202-3361
US

IV. Provider business mailing address

PO BOX 517
HAZLETON PA
18201-0517
US

V. Phone/Fax

Practice location:
  • Phone: 570-450-0870
  • Fax: 570-450-0874
Mailing address:
  • Phone: 570-450-0870
  • Fax: 570-450-0874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS005672L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: