Healthcare Provider Details

I. General information

NPI: 1962441683
Provider Name (Legal Business Name): MONIKA VANSANT D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/29/2022
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 HOLME AVE
PHILADELPHIA PA
19152-2007
US

IV. Provider business mailing address

55 IROQUOIS RD
RICHBORO PA
18954-1217
US

V. Phone/Fax

Practice location:
  • Phone: 215-335-6562
  • Fax:
Mailing address:
  • Phone: 267-992-5898
  • Fax: 187-738-2893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberOS010207L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS010207L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS010207L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: