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General NPI Number Information
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NPI Number | 1386850808
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Entity Type | Individual
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Provider Name | VIJAY KANGOTRA M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/14/2007
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 111 S 11TH ST SUITE 8490
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City | PHILADELPHIA
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State | PA
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Zip | 19107-4824
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Country | US
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Telephone | 215-955-2370
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Fax |
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Provider Business Mailing Address
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Address Line | 4551 STRUTFIELD LN APT # 4220
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City | ALEXANDRIA
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State | VA
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Zip | 22311-4967
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Country | US
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Telephone | 703-575-8194
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 0101249313
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207LP3000X
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Taxonomy Name | Pediatric Anesthesiology Physician
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License Number | MT189631
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License Number State | PA
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