Provider Demographics
NPI:1205019916
Name:VEGA MD LLC
Entity Type:Organization
Organization Name:VEGA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:E
Authorized Official - Last Name:VEGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-543-9194
Mailing Address - Street 1:100 MEDICAL ARTS BLDG
Mailing Address - Street 2:SUITE 110
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-7135
Mailing Address - Country:US
Mailing Address - Phone:724-543-9194
Mailing Address - Fax:724-543-2912
Practice Address - Street 1:100 MEDICAL ARTS BLDG
Practice Address - Street 2:SUITE 110
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-7135
Practice Address - Country:US
Practice Address - Phone:724-543-9194
Practice Address - Fax:724-543-2912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROGER E VEGA MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-17
Last Update Date:2007-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007055420002Medicaid
PA0007055420002Medicaid