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General NPI Number Information
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NPI Number | 1922548064
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Entity Type | Individual
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Provider Name | JORGE ALEXIS ROSARIO VEGA MD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 3401 N BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19140-5103
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Country | US
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Telephone | 215-707-4600
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Fax | 215-707-4034
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Provider Business Mailing Address
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Address Line | 3500 N BROAD ST RM 1A
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City | PHILADELPHIA
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State | PA
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Zip | 19140-4106
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Country | US
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Telephone | 215-926-9022
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD477282
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | MD477282
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License Number State | PA
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