Provider Demographics
NPI:1861673113
Name:JOHN D VANCE MD INC
Entity Type:Organization
Organization Name:JOHN D VANCE MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VANCE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-856-9797
Mailing Address - Street 1:1988 QUAIL RUN DR
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-1803
Mailing Address - Country:US
Mailing Address - Phone:330-637-2882
Mailing Address - Fax:
Practice Address - Street 1:735 NILES CORTLAND RD SE
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-2475
Practice Address - Country:US
Practice Address - Phone:330-856-9797
Practice Address - Fax:330-856-9684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-15
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35050152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0849087Medicaid
OHDN4013OtherRAILROAD MEDICARE
OH0552693Medicare PIN