Provider Demographics
NPI:1871660837
Name:PRAKASH K VIN MD PC
Entity Type:Organization
Organization Name:PRAKASH K VIN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAKASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:VIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-694-2765
Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627
Mailing Address - Country:US
Mailing Address - Phone:724-694-2765
Mailing Address - Fax:724-694-2870
Practice Address - Street 1:118 W FOURTH AVE
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:PA
Practice Address - Zip Code:15627
Practice Address - Country:US
Practice Address - Phone:724-694-2765
Practice Address - Fax:724-694-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037361L207R00000X, 207RG0100X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
219922OtherHEALTH AMERICA HEALTH ASS
77498OtherUSHC
PA000626144Medicaid
060480OtherUNISON
112076401OtherUPMC FOR YOU
VENDOR#0000004047OtherUPMC
1016662OtherGATEWAY
154859OtherHIGHMARK PRODUCTS
1016662OtherGATEWAY
C30274Medicare UPIN