Provider Demographics
NPI:1831120252
Name:VEGA, PATRICIA M (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
Last Name:VEGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:28555 STARBRIGHT BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5662
Mailing Address - Country:US
Mailing Address - Phone:419-931-3030
Mailing Address - Fax:419-931-3046
Practice Address - Street 1:28555 STARBRIGHT BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5662
Practice Address - Country:US
Practice Address - Phone:419-931-3030
Practice Address - Fax:419-931-3046
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35050630207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0665909Medicaid
OH9357163Medicare PIN
OHA16542Medicare UPIN