MEDICARE: MYRIAN NOELLA VINAN VEGA MD

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	208M00000X	Hospitalist Physician	59437	KY
2	207RP1001X	Pulmonary Disease Physician	59437	KY

General Provider Information

NPI Number	:	1639665433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAN NOELLA VINAN VEGA MD

Provider Business Mailing Address
First Line	:	PO BOX 632281
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-2281
Country	:	US
Telephone Number	:	124-506-8158
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 N ELM ST
Second Line	:
City	:	HENDERSON
State	:	KY
Zip	:	42420-2768
Country	:	US
Telephone Number	:	270-561-0202
Fax Number	:

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

Provider Enumeration Date	:	07/03/2018
Last Update Date	:	04/19/2026

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