Individual
FABIAN A VENGOECHEA
Active
Individual
FABIAN A VENGOECHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD427681
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007278000
MEDICAID TPI GROUP
PA
01
—
597586
MEDICARE GROUP TPI
PA
01
—
CD4829
RAIL ROAD MEDICARE GROUP TPI
PA
Enumeration date
06/10/2006
Last updated
10/11/2022
Update your record
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