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General NPI Number Information
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NPI Number | 1093761934
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Entity Type | Organization
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Legal Business Name | POCONO VASCULAR INSTITUTE PC
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 505 INDEPENDENCE RD SUITE C
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-7916
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Country | US
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Telephone | 570-421-5003
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Fax | 570-421-1401
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Provider Business Mailing Address
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Address Line | 505 INDEPENDENCE RD SUITE C
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City | EAST STROUDSBURG
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State | PA
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Zip | 18301-7916
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Country | US
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Telephone | 570-421-5003
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Fax | 570-421-1401
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Authorized Official
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Title or Position | DELEGATED OFFICIAL
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Name | DAVID BIGATEL
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Credential | M.D.
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Telephone | 570-421-5003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD051441L
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License Number State | PA
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