Healthcare Provider Details

I. General information

NPI: 1629089982
Provider Name (Legal Business Name): JOHN M VASIL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1704 PHILADELPHIA AVE
NORTHERN CAMBRIA PA
15714-1180
US

IV. Provider business mailing address

1704 PHILADELPHIA AVE
NORTHERN CAMBRIA PA
15714-1180
US

V. Phone/Fax

Practice location:
  • Phone: 814-948-0775
  • Fax: 814-948-0746
Mailing address:
  • Phone: 814-948-0775
  • Fax: 814-948-0746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS009127L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: