Provider Demographics
NPI:1073692737
Name:VATER, YOURI LEON (MD)
Entity Type:Individual
Prefix:
First Name:YOURI
Middle Name:LEON
Last Name:VATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:MC A410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:717-531-6597
Practice Address - Fax:717-531-7790
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WATR00039573207L00000X
PALT000795207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0232105OtherL&I
PA1033783000001Medicaid
WA1073692737Medicaid
251360OtherINTERNAL ID-MOTOR VEHICLE ID
WA0232105OtherL&I