Healthcare Provider Details

I. General information

NPI: 1376543165
Provider Name (Legal Business Name): VINCENT A DRAPIEWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 HANOVER ST SUITE 102
WILKES BARRE PA
18702-3549
US

IV. Provider business mailing address

166 HANOVER ST SUITE 102
WILKES BARRE PA
18702-3549
US

V. Phone/Fax

Practice location:
  • Phone: 570-822-5191
  • Fax: 570-822-2450
Mailing address:
  • Phone: 570-822-5191
  • Fax: 570-822-2450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD007591-E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: