MEDICARE: DR. VICTOR EDGARDO NIETO 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	208600000X	Surgery Physician	MD017802E	PA

General Provider Information

NPI Number	:	1679547996
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VICTOR EDGARDO NIETO MD

Provider Business Mailing Address
First Line	:	PO BOX 1549
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16003-1549
Country	:	US
Telephone Number	:	724-431-4190
Fax Number	:	724-431-4192

Provider Business Practice Location Address
First Line	:	129 ONEIDA VALLEY RD
Second Line	:	SUITE 111
City	:	BUTLER
State	:	PA
Zip	:	16001-2252
Country	:	US
Telephone Number	:	724-431-4190
Fax Number	:	724-431-4192

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

Provider Enumeration Date	:	02/14/2006
Last Update Date	:	02/07/2017

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