Provider Demographics
NPI:1366429300
Name:VINCENT F. PETRAGLIA AND ASSOCIATES P.C.
Entity type:Organization
Organization Name:VINCENT F. PETRAGLIA AND ASSOCIATES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:F
Authorized Official - Last Name:PETRAGLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:724-941-5588
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1003098OtherGATEWAY GRP NUMBER
PA842BOtherUPMC GRP NUMBER
PA0245789OtherCIGNA GRP#
PA4203149OtherAETNA GRP NUMBER
PA49467OtherUMWA GRP NUMBER
PA71784OtherTHREE RIVERS/MEDPLUS GRP
PA1003098OtherGATEWAY GRP NUMBER