MEDICARE: NIBONDH VACHARAT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD033586L	PA

General Provider Information

NPI Number	:	1386940880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NIBONDH VACHARAT

Provider Business Mailing Address
First Line	:	1413 ACADEMY LN
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2514
Country	:	US
Telephone Number	:	215-782-1047
Fax Number	:

Provider Business Practice Location Address
First Line	:	1413 ACADEMY LN
Second Line	:
City	:	ELKINS PARK
State	:	PA
Zip	:	19027-2514
Country	:	US
Telephone Number	:	215-782-1047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2011
Last Update Date	:	01/31/2011

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Directions to “ NIBONDH VACHARAT ” Practice Location

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