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General NPI Number Information
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NPI Number | 1750565263
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Entity Type | Organization
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Legal Business Name | SURYA K. VANGORE M.D. P.C
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Dates
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Enumeration Date | 12/19/2007
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Last Update Date | 03/02/2020
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Provider Practice Location Address
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Address Line | 431 W ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19120-4148
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Country | US
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Telephone | 215-455-3444
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Fax | 215-455-3445
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Provider Business Mailing Address
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Address Line | 431 W ROOSEVELT BLVD
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City | PHILADELPHIA
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State | PA
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Zip | 19120-4148
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Country | US
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Telephone | 215-455-3444
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Fax | 215-455-3445
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Authorized Official
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Title or Position | PRIMARY CARE PHYSCIAN
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Name | DR. SURYA KUMARI VANGORE
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Credential |
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Telephone | 215-455-3444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | MD038910L
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License Number State | PA
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