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General NPI Number Information
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NPI Number | 1881625200
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Entity Type | Organization
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Legal Business Name | NORTHEAST PHILADELPHIA VASCULAR SURGEONS PC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 2000 GRANT AVE SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4378
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Country | US
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Telephone | 215-969-3944
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Fax | 215-969-3886
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Provider Business Mailing Address
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Address Line | 2000 GRANT AVE SUITE 201
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City | PHILADELPHIA
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State | PA
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Zip | 19115-4378
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Country | US
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Telephone | 215-969-3944
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Fax | 215-969-3886
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHITTUR R MOHAN
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Credential | M.D.
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Telephone | 215-969-3944
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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 |
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