Individual
DR. VIDA S KANIECKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6505 MARKET ST BLDG A1, YOUNGSTOWN, OH 44512-3457
(330) 746-8040
(330) 746-8025
Mailing address
6505 MARKET ST BLDG A1, BOARDMAN, OH 44512-3457
(330) 746-8040
(330) 746-8025
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
35.134780
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012772440001
—
PA
01
—
1730131723
NPI
—
01
—
198726H87
MEDICARE PTAN
PA
Enumeration date
05/17/2006
Last updated
11/23/2020
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