Provider Demographics
NPI:1720078298
Name:VENGLARCIK, JOHN S (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:S
Last Name:VENGLARCIK
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:PO BOX 5174
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-0174
Mailing Address - Country:US
Mailing Address - Phone:330-884-3993
Mailing Address - Fax:888-439-5935
Practice Address - Street 1:819 MCKAY CT STE B3
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5771
Practice Address - Country:US
Practice Address - Phone:330-884-3993
Practice Address - Fax:888-439-5935
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-26
Last Update Date:2024-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-8666174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-04-8666OtherOHIO LICENCE
OH35-04-8666OtherOHIO LICENCE