Individual
DMITRI VASSILIEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4242
(878) 332-4485
Mailing address
12311 PERRY HWY, WEXFORD, PA 15090-8344
(878) 332-4242
(878) 332-4485
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
MD067796L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001843481
—
PA
01
—
10938106
CAQH
—
Enumeration date
05/02/2006
Last updated
12/01/2020
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