Healthcare Provider Details

I. General information

NPI: 1346287000
Provider Name (Legal Business Name): VLADIMIR ZAGREBELSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 09/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6950 GERMANTOWN AVE NEW COURTLAND LIFE
PHILADELPHIA PA
19119-2120
US

IV. Provider business mailing address

6950 GERMANTOWN AVE NEW COURTLAND LIFE
PHILADELPHIA PA
19119-2120
US

V. Phone/Fax

Practice location:
  • Phone: 215-951-4400
  • Fax: 215-951-4484
Mailing address:
  • Phone: 215-951-4400
  • Fax: 215-951-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD421961
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD421961
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: