Provider Demographics
NPI:1922061787
Name:VEGARI, MATT M (MD)
Entity Type:Individual
Prefix:DR
First Name:MATT
Middle Name:M
Last Name:VEGARI
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 1:232 INDEPENDENCE RD
Mailing Address - Street 2:
Mailing Address - City:EAST STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18301
Mailing Address - Country:US
Mailing Address - Phone:570-420-1955
Mailing Address - Fax:570-424-0707
Practice Address - Street 1:232 INDEPENDENCE RD
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301
Practice Address - Country:US
Practice Address - Phone:570-420-1955
Practice Address - Fax:570-424-0707
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2010-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD029809Y174400000X, 2084N0400X
PAMD02980942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010902720011Medicaid
PA0010902720003Medicaid
PA0010902720011Medicaid
PA0010902720003Medicaid
PAB40523Medicare UPIN