Provider Demographics
NPI:1629234851
Name:VARGAS, VINCENT BOLISAY (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:BOLISAY
Last Name:VARGAS
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 1:1719 UNION AVE STE A
Mailing Address - Street 2:
Mailing Address - City:NATRONA HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:15065-2146
Mailing Address - Country:US
Mailing Address - Phone:724-226-2128
Mailing Address - Fax:724-226-2498
Practice Address - Street 1:1719 UNION AVE STE A
Practice Address - Street 2:
Practice Address - City:NATRONA HEIGHTS
Practice Address - State:PA
Practice Address - Zip Code:15065-2146
Practice Address - Country:US
Practice Address - Phone:724-226-2128
Practice Address - Fax:724-226-2498
Is Sole Proprietor?:No
Enumeration Date:2008-08-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD443170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102619375Medicaid
PA225447Medicare PIN