Provider Demographics
NPI:1922064682
Name:MORGAN, VINCENT F (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:F
Last Name:MORGAN
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 1:205 TENNYSON AVENUE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602
Mailing Address - Country:US
Mailing Address - Phone:814-943-4800
Mailing Address - Fax:814-943-4700
Practice Address - Street 1:205 TENNYSON AVENUE
Practice Address - Street 2:SUITE C
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-943-4800
Practice Address - Fax:814-943-4700
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD041207L208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011674940002Medicaid
656869OtherBLUE SHIELD VENDER NUMBER
PA0011674940002Medicaid
MO082367Medicare ID - Type Unspecified