Provider Demographics
NPI:1497984512
Name:VIVIANO, BRIAN VINCENT (DO)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:VINCENT
Last Name:VIVIANO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LECOM PL
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-2571
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:814-868-2522
Practice Address - Street 1:2010 W 38TH ST UPPR LEVEL
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2004
Practice Address - Country:US
Practice Address - Phone:814-866-6835
Practice Address - Fax:814-866-6837
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015368207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA003151031OtherHIGHMARK
PAP01637821OtherRR MEDICARE
PA1030065750001Medicaid
PA1030065750001Medicaid