Provider Demographics
NPI:1134121957
Name:VAZQUEZ, JORGE ANTONIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JORGE
Middle Name:ANTONIO
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JORGE
Other - Middle Name:ANTONIO
Other - Last Name:DELEON VAZQUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1307 FEDERAL ST STE B100
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15212-4761
Mailing Address - Country:US
Mailing Address - Phone:412-359-8900
Mailing Address - Fax:412-359-8977
Practice Address - Street 1:1307 FEDERAL ST
Practice Address - Street 2:SUITE B100 ALLEGHENY CTR FOR DIGESTIVE HEALTH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15212-4769
Practice Address - Country:US
Practice Address - Phone:412-359-8900
Practice Address - Fax:412-359-8977
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025683E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001179978Medicaid
10938118OtherCAQH
OH2423881Medicaid
PA888586Medicare PIN
PA0011799780011Medicaid
OH2423881Medicaid
PACG2282Medicare PIN
PA100013350Medicare PIN
PAC32793Medicare UPIN
WV1806777000Medicaid
PACG2176Medicare PIN
PA0011799780010Medicaid
PA888586NHUMedicare PIN
PA100013348Medicare PIN