Healthcare Provider Details

I. General information

NPI: 1861413759
Provider Name (Legal Business Name): ANIL VACHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 CIVIC CENTER BOULEVARD WEST PAVILION - 1ST FLOOR
PHILADELPHIA PA
19104-4306
US

IV. Provider business mailing address

3400 CIVIC CENTER BOULEVARD WEST PAVILION - 1ST FLOOR
PHILADELPHIA PA
19104-4306
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-3202
  • Fax: 215-349-8432
Mailing address:
  • Phone: 215-662-3202
  • Fax: 215-349-8432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD066508L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD066508L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number337462
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: