Healthcare Provider Details

I. General information

NPI: 1053675843
Provider Name (Legal Business Name): ALTOONA VASCULAR INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2012
Last Update Date: 06/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2929 ARCH ST SUITE 1705
PHILADELPHIA PA
19104-2857
US

IV. Provider business mailing address

1915 VALLEY VIEW BLVD
ALTOONA PA
16602-6527
US

V. Phone/Fax

Practice location:
  • Phone: 215-382-3680
  • Fax: 215-240-1677
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 JR.
Title or Position: CEO
Credential: MD
Phone: 215-382-3680