MEDICARE: AMARESH VANGA M.D.

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	207RN0300X	Nephrology Physician	0101242118	VA

General Provider Information

NPI Number	:	1265421275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMARESH VANGA M.D.

Provider Business Mailing Address
First Line	:	3235 ACADEMY AVE STE 301
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-3200
Country	:	US
Telephone Number	:	757-484-9400
Fax Number	:	757-484-8809

Provider Business Practice Location Address
First Line	:	3235 ACADEMY AVE STE 301
Second Line	:
City	:	PORTSMOUTH
State	:	VA
Zip	:	23703-3200
Country	:	US
Telephone Number	:	757-484-9400
Fax Number	:	757-484-8809

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	05/11/2020

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