Provider Demographics
NPI:1356351290
Name:VUCINICH, DANA (MD)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:VUCINICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 14397
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-7397
Mailing Address - Country:US
Mailing Address - Phone:330-758-2775
Mailing Address - Fax:330-758-2787
Practice Address - Street 1:1000 S MERCER ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4672
Practice Address - Country:US
Practice Address - Phone:330-758-2775
Practice Address - Fax:330-758-2787
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-043048-L174400000X
PAMD043048L207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA022101OtherBLUE SHIELD
PA0014866920005Medicaid
PAF81396Medicare UPIN
PA022101OtherBLUE SHIELD