MEDICARE: DR. NEETU B VASU 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	207KA0200X	Allergy Physician	25MA10664500	NJ
2	207KA0200X	Allergy Physician	MD468870	PA
3	207R00000X	Internal Medicine Physician	MD468870	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D0074868	OTHER	MD	MD LICENSE

General Provider Information

NPI Number	:	1598966707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEETU B VASU M.D.

Provider Business Mailing Address
First Line	:	255 S 17TH ST STE 1104
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6212
Country	:	US
Telephone Number	:	215-515-5999
Fax Number	:	215-545-1384

Provider Business Practice Location Address
First Line	:	255 S 17TH ST STE 1104
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6212
Country	:	US
Telephone Number	:	215-515-5999
Fax Number	:	215-545-1384

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

Provider Enumeration Date	:	05/29/2007
Last Update Date	:	11/01/2019

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