Provider Demographics
NPI:1912984170
Name:PETRAGLIA, VINCENT F (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:F
Last Name:PETRAGLIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 VALLEYBROOK RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MC MURRAY
Mailing Address - State:PA
Mailing Address - Zip Code:15317-3367
Mailing Address - Country:US
Mailing Address - Phone:724-941-5588
Mailing Address - Fax:724-941-1458
Practice Address - Street 1:455 VALLEYBROOK RD
Practice Address - Street 2:SUITE 300
Practice Address - City:MC MURRAY
Practice Address - State:PA
Practice Address - Zip Code:15317-3367
Practice Address - Country:US
Practice Address - Phone:724-941-5588
Practice Address - Fax:724-941-1458
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-29
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003395L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA080190708OtherRAILROAD MEDICARE
PA0006076950006Medicaid
PA156479OtherPA-HIGHMARK
PA3017472OtherAETNA-MCMURRAY OFFICE
PA156479OtherPA-HIGHMARK
PA0006076950006Medicaid