Healthcare Provider Details

I. General information

NPI: 1881625200
Provider Name (Legal Business Name): NORTHEAST PHILADELPHIA VASCULAR SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 11/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 GRANT AVE SUITE 201
PHILADELPHIA PA
19115-4378
US

IV. Provider business mailing address

2000 GRANT AVE SUITE 201
PHILADELPHIA PA
19115-4378
US

V. Phone/Fax

Practice location:
  • Phone: 215-969-3944
  • Fax: 215-969-3886
Mailing address:
  • Phone: 215-969-3944
  • Fax: 215-969-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: CHITTUR R MOHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 215-969-3944