Basic Information
| Provider Information | |||||||||
| NPI: | 1366429300 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VINCENT F. PETRAGLIA AND ASSOCIATES P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 455 VALLEYBROOK RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249415588 | ||||||||
| FaxNumber: | 7249411458 | ||||||||
| Practice Location | |||||||||
| Address1: | 455 VALLEYBROOK RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | MC MURRAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 153173367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7249415588 | ||||||||
| FaxNumber: | 7249411458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/30/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | PETRAGLIA | ||||||||
| AuthorizedOfficialFirstName: | VINCENT | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7249415588 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1003098 | 01 | PA | GATEWAY GRP NUMBER | OTHER | 842B | 01 | PA | UPMC GRP NUMBER | OTHER | 0245789 | 01 | PA | CIGNA GRP# | OTHER | 4203149 | 01 | PA | AETNA GRP NUMBER | OTHER | 49467 | 01 | PA | UMWA GRP NUMBER | OTHER | 71784 | 01 | PA | THREE RIVERS/MEDPLUS GRP | OTHER |