Healthcare Provider Details

I. General information

NPI: 1326310806
Provider Name (Legal Business Name): PA VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 03/13/2020
Certification Date: 03/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 INDEPENDENCE RD STE E
EAST STROUDSBURG PA
18301-7916
US

IV. Provider business mailing address

505 INDEPENDENCE RD STE E
EAST STROUDSBURG PA
18301-7916
US

V. Phone/Fax

Practice location:
  • Phone: 215-382-3680
  • Fax: 215-240-1677
Mailing address:
  • Phone: 215-382-3680
  • Fax: 215-240-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

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