Provider Demographics
NPI:1811915036
Name:VIGNA, JOHN ROBERT (PSYD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ROBERT
Last Name:VIGNA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 ALLEGHENY RIVER BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:OAKMONT
Mailing Address - State:PA
Mailing Address - Zip Code:15139-1655
Mailing Address - Country:US
Mailing Address - Phone:412-826-9151
Mailing Address - Fax:412-826-9112
Practice Address - Street 1:508 ALLEGHENY RIVER BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:OAKMONT
Practice Address - State:PA
Practice Address - Zip Code:15139-1655
Practice Address - Country:US
Practice Address - Phone:412-826-9151
Practice Address - Fax:412-826-9112
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-006182-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0548084Medicaid
S32629Medicare UPIN
PA0548084Medicaid