Provider Demographics
NPI:1750578555
Name:VINCENT N GRATTOLINO DPM
Entity type:Organization
Organization Name:VINCENT N GRATTOLINO DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:N
Authorized Official - Last Name:GRATTOLINO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:570-344-3338
Mailing Address - Street 1:203 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18504-3303
Mailing Address - Country:US
Mailing Address - Phone:570-344-3338
Mailing Address - Fax:570-963-0534
Practice Address - Street 1:203 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18504-3303
Practice Address - Country:US
Practice Address - Phone:570-344-3338
Practice Address - Fax:570-963-0534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002316L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT28274Medicare UPIN
PA0696380001Medicare NSC
PA081643Medicare PIN