Provider Demographics
NPI:1598702375
Name:VAKIOS, JOHN PETER (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:VAKIOS
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:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:SAYRE
Mailing Address - State:PA
Mailing Address - Zip Code:18840-0188
Mailing Address - Country:US
Mailing Address - Phone:570-882-4048
Mailing Address - Fax:570-882-5166
Practice Address - Street 1:ONE GUTHRIE SQUARE
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840
Practice Address - Country:US
Practice Address - Phone:570-882-4048
Practice Address - Fax:570-822-5166
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1934922085R0001X, 2085R0203X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACC9269OtherRR MEDICARE GROUP ID
PAP00635209OtherRR MEDICARE PIN
NY01897236Medicaid
NY931431Medicare ID - Type Unspecified
PAP00635209OtherRR MEDICARE PIN