MEDICARE: FELIX VERSHVOVSKY MD

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	207Q00000X	Family Medicine Physician	247248	NY
2	207Q00000X	Family Medicine Physician	MD-433799	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00633382	OTHER	PA	RAILROAD MEDICARE
2	597586	OTHER	PA	MEDICARE GROUP
3	CD4829	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164690327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIX VERSHVOVSKY MD

Provider Business Mailing Address
First Line	:	PO BOX 820933
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19182-0933
Country	:	US
Telephone Number	:	215-926-9010
Fax Number	:	215-226-8285

Provider Business Practice Location Address
First Line	:	2100 W GIRARD AVE
Second Line	:
City	:	PHILA
State	:	PA
Zip	:	19130-1400
Country	:	US
Telephone Number	:	215-685-0800
Fax Number	:	215-685-0846

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

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	07/19/2011

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Directions to “ FELIX VERSHVOVSKY MD” Practice Location

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