Provider Demographics
NPI:1902892813
Name:VIN, PRAKASH K (MD)
Entity Type:Individual
Prefix:
First Name:PRAKASH
Middle Name:K
Last Name:VIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 215
Mailing Address - Street 2:118 W FOURTH AVE
Mailing Address - City:DERRY
Mailing Address - State:PA
Mailing Address - Zip Code:15627-0215
Mailing Address - Country:US
Mailing Address - Phone:724-694-2765
Mailing Address - Fax:724-694-2870
Practice Address - Street 1:118 W 4TH AVE
Practice Address - Street 2:
Practice Address - City:DERRY
Practice Address - State:PA
Practice Address - Zip Code:15627-1252
Practice Address - Country:US
Practice Address - Phone:724-694-2765
Practice Address - Fax:724-694-2870
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD037361L207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11440OtherHEALTH AM HEALTHASSUR
060480OtherTHREE RIVERS HEALTH PLAN
PA000626144Medicaid
1016662OtherGATEWAY
112076401OtherUPMC FOR YOU
77498OtherUSHC
PA154859OtherHIGHMARK PRODUCTS
11440OtherHEALTH AM HEALTHASSUR
PA154859Medicare ID - Type Unspecified