Provider Demographics
NPI:1184620148
Name:SEPESKY, VICTORIA M (MD)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:M
Last Name:SEPESKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:M
Other - Last Name:IACOVANGELO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 SCENERY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONESSEN
Mailing Address - State:PA
Mailing Address - Zip Code:15062-2210
Mailing Address - Country:US
Mailing Address - Phone:724-684-9652
Mailing Address - Fax:
Practice Address - Street 1:1295 GRAND BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MONESSEN
Practice Address - State:PA
Practice Address - Zip Code:15062-1955
Practice Address - Country:US
Practice Address - Phone:724-684-4150
Practice Address - Fax:724-684-4189
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD065930L2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001729333Medicaid
PAG85383Medicare UPIN