Provider Demographics
NPI:1265502900
Name:VINNIKOV, OLEG (MD)
Entity Type:Individual
Prefix:
First Name:OLEG
Middle Name:
Last Name:VINNIKOV
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 1:599 W STATE ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:DOYLESTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18901
Mailing Address - Country:US
Mailing Address - Phone:215-345-2885
Mailing Address - Fax:215-345-2552
Practice Address - Street 1:595 W STATE ST
Practice Address - Street 2:DOYLESTOWN HOSPITAL
Practice Address - City:DOYLESTOWN
Practice Address - State:PA
Practice Address - Zip Code:18901
Practice Address - Country:US
Practice Address - Phone:215-345-2885
Practice Address - Fax:215-345-2552
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425595207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I25260Medicare UPIN
PA088205Medicare ID - Type Unspecified