Healthcare Provider Details

I. General information

NPI: 1164690327
Provider Name (Legal Business Name): FELIX VERSHVOVSKY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2008
Last Update Date: 07/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 W GIRARD AVE
PHILA PA
19130-1400
US

IV. Provider business mailing address

PO BOX 820933
PHILA PA
19182-0933
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-0800
  • Fax: 215-685-0846
Mailing address:
  • Phone: 215-926-9010
  • Fax: 215-226-8285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number247248
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD-433799
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: