Provider Demographics
NPI:1023144078
Name:VARGO, BETHANY C (PA-C)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:C
Last Name:VARGO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BETHANY
Other - Middle Name:C
Other - Last Name:HUTSKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 E CHURCH ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2272
Mailing Address - Country:US
Mailing Address - Phone:814-444-6260
Mailing Address - Fax:144-431-2498
Practice Address - Street 1:126 E CHURCH ST STE 2300
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2272
Practice Address - Country:US
Practice Address - Phone:814-444-6260
Practice Address - Fax:144-431-2498
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052687363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA10319603Medicaid
PA10319603Medicaid