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General NPI Number Information
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NPI Number | 1578625349
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Entity Type | Organization
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Legal Business Name | PENNSYLVANIA VASCULAR ASSOCIATES, P.C.
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 01/10/2013
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Provider Practice Location Address
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Address Line | 700 SPRUCE STREET STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19106-0423
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Country | US
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Telephone | 215-829-5000
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Fax | 215-627-0578
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Provider Business Mailing Address
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Address Line | 700 SPRUCE STREET STE 101
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City | PHILADELPHIA
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State | PA
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Zip | 19106-0423
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Country | US
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Telephone | 215-829-5000
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Fax | 215-627-0578
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MS. BRIDGET ANNE WALSH
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Credential |
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Telephone | 215-829-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State | PA
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