Healthcare Provider Details

I. General information

NPI: 1447256342
Provider Name (Legal Business Name): PRAFULLCHANDRA DOLATRAI VORA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: PRAFUL D VORA .M.D.

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

249 ELM DRIVE
WAYNESBURG PA
15370
US

IV. Provider business mailing address

249 ELM DR
WAYNESBURG PA
15370-8275
US

V. Phone/Fax

Practice location:
  • Phone: 724-627-8131
  • Fax:
Mailing address:
  • Phone: 724-627-8131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD023883E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD023883E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: