MEDICARE: PAVAN ANIL VASWANI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	2084N0400X	Neurology Physician	MD470028	PA

General Provider Information

NPI Number	:	1073900700
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAVAN ANIL VASWANI

Provider Business Mailing Address
First Line	:	330 S 9TH ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6103
Country	:	US
Telephone Number	:	215-829-7512
Fax Number	:	215-829-6606

Provider Business Practice Location Address
First Line	:	330 S 9TH ST FL 3
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-6103
Country	:	US
Telephone Number	:	215-829-7512
Fax Number	:	215-829-6606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	06/27/2020

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Directions to “ PAVAN ANIL VASWANI ” Practice Location

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