Provider Demographics
NPI:1558774133
Name:JOHN S VENGLARCIK III
Entity Type:Organization
Organization Name:JOHN S VENGLARCIK III
Other - Org Name:JOHN S VENGLARCIK III, MD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:VENGLARCIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-884-3993
Mailing Address - Street 1:819 MCKAY CT STE B3
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5771
Mailing Address - Country:US
Mailing Address - Phone:330-884-3993
Mailing Address - Fax:888-439-5935
Practice Address - Street 1:819 MCKAY CT STE B3
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5771
Practice Address - Country:US
Practice Address - Phone:330-884-3993
Practice Address - Fax:330-884-0516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3504886662080P0208X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0208XAllopathic & Osteopathic PhysiciansPediatricsPediatric Infectious DiseasesGroup - Single Specialty