Healthcare Provider Details

I. General information

NPI: 1841691169
Provider Name (Legal Business Name): LEHIGH VALLEY VASCULAR CENTER LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2014
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 INDEPENDENCE RD
EAST STROUDSBURG PA
18301-7916
US

IV. Provider business mailing address

2929 ARCH ST SUITE 1705
PHILADELPHIA PA
19104-2857
US

V. Phone/Fax

Practice location:
  • Phone: 570-421-5997
  • Fax:
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: JAMES MCGUCKIN
Title or Position: CEO
Credential: MD
Phone: 215-382-3680