Vladimir Petorak Jr., MD

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

MD043726L Issued in PA

Practice address

90 Medical Park Dr
Lewisburg, PA 17837-6343

Phone

(570) 524-2722

Fax

(570) 524-0362

NPI assigned

Nov 14, 2005

Last updated

Jun 9, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

• Central Penn Gastroenterology Associates

  • Specialist
  • Lewisburg, PA
  • NPI 1982686226
  Authorized official Same address or phone

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

{
    "created_epoch": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1871575134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR STE 306",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178379350",
            "telephone_number": "570-522-4110",
            "fax_number": "570-768-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "90 MEDICAL PARK DR",
            "city": "LEWISBURG",
            "state": "PA",
            "postal_code": "178376343",
            "telephone_number": "570-524-2722",
            "fax_number": "570-524-0362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETORAK",
        "first_name": "VLADIMIR",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "PA",
            "license": "MD043726L",
            "primary": false
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "PA",
            "license": "MD043726L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0014277710004",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jacinta Perez Rodriguez Wood, D.O.
• Kathryn Persun
• Kimberly A Pesarchick, PA-C
• Karen S Pesillo, PHDHP
• Phillip Robert Peterson, M.D.
• Dana Pfeifer, CRNP
• Haley Nicole Phillips, DOCTORATE
• Phoenix Rehabilitation and Health Services, Inc.
• Amanda Marie Piccione, PA-C
• Suzanne I Pick

• Gastroenterology Physician in Lewisburg, PA
• Providers in Lewisburg, PA by specialty
• Gastroenterology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.