Basic Information
Provider Information | |||||||||
NPI: | 1659527026 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VUKELIC | ||||||||
FirstName: | VALARIE | ||||||||
MiddleName: | MEREDITH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | D.O. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 11279 PERRY HWY | ||||||||
Address2: | SUITE 450 | ||||||||
City: | WEXFORD | ||||||||
State: | PA | ||||||||
PostalCode: | 150909381 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7249331100 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1 BRADDOCK ROAD AVENUE | ||||||||
Address2: | SUITE C | ||||||||
City: | MOUNT PLEASANT | ||||||||
State: | PA | ||||||||
PostalCode: | 156661458 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7245475103 | ||||||||
FaxNumber: | 7245476147 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/17/2008 | ||||||||
LastUpdateDate: | 04/24/2017 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | OS016810 | PA | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
No ID Information.