Provider Demographics
NPI:1700069101
Name:BACASNOT, JEROME VINCENT VENTURINA (MD)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:VINCENT VENTURINA
Last Name:BACASNOT
Suffix:
Gender:M
Credentials:MD
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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:17403-3051
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:YORK HOSPITAL DEPARTMENT OF EMERGENCY MEDICINE
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2450
Practice Address - Fax:717-851-3469
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2009-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD434659207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA20076940OtherAMERIHEALTH MERCY-WMG
PA211500OtherJOHNS HOPKINS
PA102168935Medicaid
PA118663OtherGEISINGER HEALTH PLAN
PA50079323OtherCAPITAL BLUE CROSS-WMG
PA248111OtherUNISON-WMG
PA9864197OtherAETNA
PA1572369OtherGATEWAY-WMG
PA2067460OtherHIGHMARK BLUE SHIELD
PA20076940OtherAMERIHEALTH MERCY-WMG
PAP00669492Medicare PIN