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General NPI Number Information
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NPI Number | 1568414142
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Entity Type | Individual
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Provider Name | MATTHEW S VASKO MD
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 12/07/2020
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Provider Practice Location Address
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Address Line | 104 DIAMOND DR
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City | ANNA
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State | OH
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Zip | 45302
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Country | US
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Telephone | 937-394-2900
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Fax | 937-394-3602
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Provider Business Mailing Address
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Address Line | 915 WEST MICHIGAN ST
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City | SIDNEY
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State | OH
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Zip | 45365-2401
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Country | US
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Telephone | 937-394-2900
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Fax | 937-394-3602
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 35-086084
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License Number State | OH
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