MEDICARE: DR. JULIA ANGELA ELCOCK-VENGEN 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	207Q00000X	Family Medicine Physician	MD062119L	PA

Other Identifiers

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

General Provider Information

NPI Number	:	1578575940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA ANGELA ELCOCK-VENGEN M.D.

Provider Business Mailing Address
First Line	:	1401 S 31ST ST
Second Line	:	2ND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3506
Country	:	US
Telephone Number	:	215-925-2400
Fax Number	:	215-925-9162

Provider Business Practice Location Address
First Line	:	1401 S 31ST ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19146-3506
Country	:	US
Telephone Number	:	215-755-7700
Fax Number	:	215-755-3177

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	04/06/2017

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