Provider Demographics
NPI:1922081272
Name:VERA, LUIS A (MD)
Entity type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:VERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:12 CHERRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-7256
Mailing Address - Country:US
Mailing Address - Phone:570-881-0305
Mailing Address - Fax:570-330-1870
Practice Address - Street 1:206 E BROWN ST
Practice Address - Street 2:
Practice Address - City:EAST STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18301-3006
Practice Address - Country:US
Practice Address - Phone:570-422-8288
Practice Address - Fax:570-476-3754
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD044330L2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1248476Medicaid
PA1248476Medicaid
PA675509Medicare ID - Type Unspecified
PA675509Medicare PIN