Provider Demographics
NPI:1629089982
Name:VASIL, JOHN M (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:VASIL
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 1:1704 PHILADELPHIA AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHERN CAMBRIA
Mailing Address - State:PA
Mailing Address - Zip Code:15714-1180
Mailing Address - Country:US
Mailing Address - Phone:814-948-0775
Mailing Address - Fax:814-948-0746
Practice Address - Street 1:1704 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:NORTHERN CAMBRIA
Practice Address - State:PA
Practice Address - Zip Code:15714-1180
Practice Address - Country:US
Practice Address - Phone:814-948-0775
Practice Address - Fax:814-948-0746
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS009127L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017035060002Medicaid
PAN5VA975689OtherBLUE SHIELD
PAG78269Medicare UPIN
PA0017035060002Medicaid