Provider Demographics
NPI:1861828444
Name:MORALES-VICENTE, EDUARDO JAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:JAVIER
Last Name:MORALES-VICENTE
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 1:139 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-1312
Mailing Address - Country:US
Mailing Address - Phone:877-675-2234
Mailing Address - Fax:
Practice Address - Street 1:2666 W STATE ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-1825
Practice Address - Country:US
Practice Address - Phone:716-701-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAFM1437599208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty