Provider Demographics
NPI:1497789135
Name:DIGIOVANNI, VINCENT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOHN
Last Name:DIGIOVANNI
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 1:575 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6944
Mailing Address - Country:US
Mailing Address - Phone:570-270-5050
Mailing Address - Fax:570-270-5550
Practice Address - Street 1:575 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6944
Practice Address - Country:US
Practice Address - Phone:570-270-5050
Practice Address - Fax:570-270-5550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD031156E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00096660000001Medicaid
092945Medicare ID - Type Unspecified
PA00096660000001Medicaid