MEDICARE: DR. VINCENT BOLISAY VARGAS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD443170	PA

General Provider Information

NPI Number	:	1629234851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT BOLISAY VARGAS M.D.

Provider Business Mailing Address
First Line	:	1719 UNION AVE STE A
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2146
Country	:	US
Telephone Number	:	724-226-2128
Fax Number	:	724-226-2498

Provider Business Practice Location Address
First Line	:	1719 UNION AVE STE A
Second Line	:
City	:	NATRONA HEIGHTS
State	:	PA
Zip	:	15065-2146
Country	:	US
Telephone Number	:	724-226-2128
Fax Number	:	724-226-2498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2008
Last Update Date	:	10/07/2020

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