Provider Demographics
NPI:1962478495
Name:VERGIS, EMANUEL N (MD)
Entity Type:Individual
Prefix:DR
First Name:EMANUEL
Middle Name:N
Last Name:VERGIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:130 SUTTER ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94104-4009
Mailing Address - Country:US
Mailing Address - Phone:415-658-6791
Mailing Address - Fax:415-520-0904
Practice Address - Street 1:518A CASTRO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94114-2512
Practice Address - Country:US
Practice Address - Phone:415-552-2814
Practice Address - Fax:415-552-2909
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2018-03-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG144834207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1962478495Medicaid
PA768386EXAMedicare ID - Type Unspecified