Provider Demographics
NPI:1043295843
Name:VARGO, EDWARD R JR (RPAC)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:VARGO
Suffix:JR
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 ORCHARD PARK RD
Mailing Address - Street 2:STE A105
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2646
Mailing Address - Country:US
Mailing Address - Phone:716-677-6000
Mailing Address - Fax:716-677-6006
Practice Address - Street 1:550 ORCHARD PARK RD
Practice Address - Street 2:STE A105
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2646
Practice Address - Country:US
Practice Address - Phone:716-677-6000
Practice Address - Fax:716-677-6006
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0069691363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00026502301OtherUNIVERA HEALTHCARE
NY000570211001OtherBLUE CROSS BLUE SHIELD
NY01998627Medicaid
NY9512129OtherINDEPENDENT HEALTH
S85618Medicare UPIN
BB5862Medicare ID - Type Unspecified