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General NPI Number Information
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NPI Number | 1558074195
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Entity Type | Organization
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Legal Business Name | DELAWARE VASCULAR INSTITUTE LLC
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Dates
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Enumeration Date | 12/28/2022
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Last Update Date | 12/28/2022
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Provider Practice Location Address
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Address Line | 5600 CHESTNUT ST
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City | PHILADELPHIA
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State | PA
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Zip | 19139-3232
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Country | US
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Telephone | 215-836-1508
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Fax |
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Provider Business Mailing Address
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Address Line | 585 COUNTY LINE RD
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City | RADNOR
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State | PA
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Zip | 19087-3718
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES MCGUCKIN
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Credential | MD
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Telephone | 215-836-1508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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