MEDICARE: DR. NICOLAS TROYANO-VAZQUEZ PHD

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	103TC1900X	Counseling Psychologist	PS016233	PA

General Provider Information

NPI Number	:	1306066964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICOLAS TROYANO-VAZQUEZ PHD

Provider Business Mailing Address
First Line	:	2833 TYSON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1415
Country	:	US
Telephone Number	:	215-624-1300
Fax Number	:	215-624-7339

Provider Business Practice Location Address
First Line	:	2833 TYSON AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19149-1415
Country	:	US
Telephone Number	:	215-624-1300
Fax Number	:	215-624-7339

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/08/2007

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