Provider Demographics
NPI:1053381442
Name:PACZKOSKIE, VINCENT J (M D)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:J
Last Name:PACZKOSKIE
Suffix:
Gender:M
Credentials:M D
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Other - Credentials:
Mailing Address - Street 1:11277 VERNON PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3717
Mailing Address - Country:US
Mailing Address - Phone:814-724-1252
Mailing Address - Fax:814-333-8871
Practice Address - Street 1:11277 VERNON PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3717
Practice Address - Country:US
Practice Address - Phone:814-724-1252
Practice Address - Fax:814-333-8871
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2016-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD066642L207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0017974780001Medicaid
PA0017974780001Medicaid
PA037124EMHMedicare PIN