Provider Demographics
NPI:1649244088
Name:VAGLIA, AMANDA J (DO)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:J
Last Name:VAGLIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:349 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:CLYMER
Mailing Address - State:PA
Mailing Address - Zip Code:15728
Mailing Address - Country:US
Mailing Address - Phone:724-254-4314
Mailing Address - Fax:724-254-2350
Practice Address - Street 1:349 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:CLYMER
Practice Address - State:PA
Practice Address - Zip Code:15728
Practice Address - Country:US
Practice Address - Phone:724-254-4314
Practice Address - Fax:724-254-2350
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012706207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010770770001Medicaid
081580NEBMedicare PIN
PAH97376Medicare UPIN