MEDICARE: VINCENT J BOBBY DO

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	207RN0300X	Nephrology Physician	OS005672L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811962780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT J BOBBY DO

Provider Business Mailing Address
First Line	:	PO BOX 517
Second Line	:
City	:	HAZLETON
State	:	PA
Zip	:	18201-0517
Country	:	US
Telephone Number	:	570-450-0870
Fax Number	:	570-450-0874

Provider Business Practice Location Address
First Line	:	426 AIRPORT RD
Second Line	:
City	:	HAZLE TOWNSHIP
State	:	PA
Zip	:	18202-3361
Country	:	US
Telephone Number	:	570-450-0870
Fax Number	:	570-450-0874

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	10/19/2022

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