MEDICARE: DONALD UNDERWOOD DO

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	2085R0204X	Vascular & Interventional Radiology Physician	OS007108E	PA

General Provider Information

NPI Number	:	1932180890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD UNDERWOOD DO

Provider Business Mailing Address
First Line	:	1500 MARKET ST
Second Line	:	24TH FLOOR-WEST TOWER
City	:	PHILA
State	:	PA
Zip	:	19102-2100
Country	:	US
Telephone Number	:	215-255-3828
Fax Number	:	215-255-3577

Provider Business Practice Location Address
First Line	:	230 N BROAD ST
Second Line	:	MS310
City	:	PHILA
State	:	PA
Zip	:	19102-1121
Country	:	US
Telephone Number	:	215-762-1808
Fax Number	:	215-762-4721

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	11/07/2014

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