Healthcare Provider Details

I. General information

NPI: 1699774257
Provider Name (Legal Business Name): IMAGE GUIDED SURGERY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5735 RIDGE AVE STE 106
PHILADELPHIA PA
19128-1745
US

IV. Provider business mailing address

5735 RIDGE AVE STE 106
PHILADELPHIA PA
19128-1745
US

V. Phone/Fax

Practice location:
  • Phone: 215-508-5261
  • Fax:
Mailing address:
  • Phone: 215-508-5261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: ROBERT WORTHINGTON-KIRSCH
Title or Position: CONVENTIONAL RADIOLOGIST
Credential: M.D.
Phone: 215-508-5261