Provider Demographics
NPI:1952300741
Name:PRESTON, VERNON H (MD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:H
Last Name:PRESTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-632-7478
Practice Address - Street 1:100 FREDERICK ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-3506
Practice Address - Country:US
Practice Address - Phone:717-851-7050
Practice Address - Fax:717-632-7478
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD025485E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP002328OtherGATEWAY
PA000904288Medicaid
PA068380OtherHIGHMARK BLUE SHIELD
PA30112631OtherAMERIHEALTH MERCY - WMG
PA068380FLTMedicare PIN
PA000904288Medicaid
PA068380Medicare PIN
PAB34816Medicare UPIN