Healthcare Provider Details

I. General information

NPI: 1861857906
Provider Name (Legal Business Name): LEHIGH VALLEY VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2015
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 HIGH POINT BLVD
BETHLEHEM PA
18017-7801
US

IV. Provider business mailing address

3450 HIGH POINT BLVD
BETHLEHEM PA
18017-7801
US

V. Phone/Fax

Practice location:
  • Phone: 215-382-3680
  • Fax:
Mailing address:
  • Phone: 610-266-7644
  • Fax: 610-881-4050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES MCGUCKIN
Title or Position: CEO
Credential: MD
Phone: 215-382-3680