MEDICARE: PRAKASH K VIN MD PC

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	207RG0100X	Gastroenterology Physician	MD037361L	PA
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	MD037361L	PA
3	207R00000X	Internal Medicine Physician	MD037361L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	219922	OTHER	HEALTH AMERICA HEALTH ASS
2	77498	OTHER	USHC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	060480	OTHER	UNISON
5	112076401	OTHER	UPMC FOR YOU
6	VENDOR#0000004047	OTHER	UPMC
7	1016662	OTHER	GATEWAY
8	154859	OTHER	HIGHMARK PRODUCTS

General Provider Information

NPI Number	:	1871660837
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRAKASH K VIN MD PC

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:
City	:	DERRY
State	:	PA
Zip	:	15627
Country	:	US
Telephone Number	:	724-694-2765
Fax Number	:	724-694-2870

Provider Business Practice Location Address
First Line	:	118 W FOURTH AVE
Second Line	:
City	:	DERRY
State	:	PA
Zip	:	15627
Country	:	US
Telephone Number	:	724-694-2765
Fax Number	:	724-694-2870

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PRAKASH K VIN
Credential	:	MD
Telephone Number	:	724-694-2765

Provider Enumeration Date	:	11/28/2006
Last Update Date	:	10/01/2013

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118 W 4TH AVE
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15627-1252

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Directions to “PRAKASH K VIN MD PC ” Practice Location

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