MEDICARE: PRAKASH K VIN 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	207R00000X	Internal Medicine Physician	MD037361L	PA
2	207RG0100X	Gastroenterology Physician	MD037361L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11440	OTHER		HEALTH AM HEALTHASSUR
2	060480	OTHER		THREE RIVERS HEALTH PLAN
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1016662	OTHER		GATEWAY
5	112076401	OTHER		UPMC FOR YOU
6	77498	OTHER		USHC
7	154859	OTHER	PA	HIGHMARK PRODUCTS

General Provider Information

NPI Number	:	1902892813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRAKASH K VIN MD

Provider Business Mailing Address
First Line	:	PO BOX 215
Second Line	:	118 W FOURTH AVE
City	:	DERRY
State	:	PA
Zip	:	15627-0215
Country	:	US
Telephone Number	:	724-694-2765
Fax Number	:	724-694-2870

Provider Business Practice Location Address
First Line	:	118 W 4TH AVE
Second Line	:
City	:	DERRY
State	:	PA
Zip	:	15627-1252
Country	:	US
Telephone Number	:	724-694-2765
Fax Number	:	724-694-2870

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

Provider Enumeration Date	:	09/26/2005
Last Update Date	:	10/02/2013

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Directions to “ PRAKASH K VIN MD” Practice Location

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