Mark K Vatavuk, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

MD021568E Issued in PA

Practice address

311 W 24TH St Ste 305
Erie, PA 16502-2666

Phone

(814) 454-4484

Fax

(814) 452-7005

NPI assigned

Jan 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: mvatavuk150989@direct.ahn.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Saint Vincent Medical Education and Research Institute

  • Family Medicine Physician
  • Albion, PA
  • NPI 1558462259
  NPD (past)
• Saint Vincent Medical Education and Research Institute Inc

  • Clinical Medical Laboratory
  • Erie, PA
  • NPI 1275771230
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1137110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602115200000",
    "number": "1184603508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 W 24TH ST STE 305",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022666",
            "telephone_number": "814-454-4484",
            "fax_number": "814-452-7005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 W 24TH ST STE 305",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165022666",
            "telephone_number": "814-454-4484",
            "fax_number": "814-452-7005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VATAVUK",
        "first_name": "MARK",
        "middle_name": "K",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-13",
        "last_updated": "2020-10-08",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD021568E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000712108",
            "state": "PA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mvatavuk150989@direct.ahn.org",
            "affiliation": "N",
            "address_1": "311 W 24th St Ste 305",
            "city": "Erie",
            "state": "PA",
            "country_code": "US",
            "postal_code": "165022666",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Cereta Renee Varney, LPN
• Ivan Varquez
• Kylene Vas
• Vascular & Endovascular Surgical Associates Inc
• Pamela M Vasil, PT
• Bobbi Jo Vaughn, LSW
• Stephanie Marie Vaughn
• Kristi Lyn Vavala, MS, BCBA
• Daniel Vay
• Laurence William Veihdeffer, DMD

• Family Medicine Physician in Erie, PA
• Providers in Erie, PA by specialty
• Family Medicine Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.