Healthcare Provider Details

I. General information

NPI: 1497782536
Provider Name (Legal Business Name): ANTHONY P VEGLIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 09/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 N CHURCH ST
HAZLETON PA
18202-9383
US

IV. Provider business mailing address

1525 N CHURCH ST
HAZLETON PA
18202-9383
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-5554
  • Fax: 570-454-5967
Mailing address:
  • Phone: 570-454-5554
  • Fax: 570-454-5967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD029359E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0010370230006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1394
Identifier TypeOTHER
Identifier State
Identifier IssuerFIRST PRIORITY OF NEPA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: