MEDICARE: DR. ROSS IRA WANK 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	2085B0100X	Body Imaging Physician	MT191722	PA
2	2085R0202X	Diagnostic Radiology Physician	MT191722	PA

General Provider Information

NPI Number	:	1649457235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSS IRA WANK M.D.

Provider Business Mailing Address
First Line	:	1411 WALNUT ST
Second Line	:	APARTMENT 403
City	:	PHILADELPHIA
State	:	PA
Zip	:	19102-3129
Country	:	US
Telephone Number	:	917-301-1737
Fax Number	:

Provider Business Practice Location Address
First Line	:	132 S. 10TH STREET
Second Line	:	DEPARTMENT OF RADIOLOGY 1087 MAIN BLDG.
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-5244
Country	:	US
Telephone Number	:	917-301-1737
Fax Number	:

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

Provider Enumeration Date	:	01/25/2008
Last Update Date	:	01/25/2008

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