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NPI Code Detail

MEDICARE: RADIANCE MEDICAL GROUP

MEDICARE: RADIANCE MEDICAL GROUP
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MD427968OTHERPAPA

General Provider Information

NPI Number : 1740837442
Entity Type Code : Organization
Provider Name (Legal Business Name) : RADIANCE MEDICAL GROUP
Provider Business Mailing Address
First Line : 1141 S 13TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-4534
Country : US
Telephone Number : 215-792-4212
Fax Number : 215-274-0464
Provider Business Practice Location Address
First Line : 1229 S 6TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19147-4837
Country : US
Telephone Number : 215-792-4212
Fax Number : 267-361-0666
Authorized Official
Title or Position : OWNER
Name : DR. VICTORIA BORGIA
Credential : MD
Telephone Number : 267-809-1799
Provider Enumeration Date : 08/19/2019
Last Update Date : 10/03/2025

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Directions to “RADIANCE MEDICAL GROUP ” Practice Location

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