MEDICARE: VICTORY MEDICAL OF PENNSYLVANIA PC

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	207RC0000X	Cardiovascular Disease Physician
2	2085R0204X	Vascular & Interventional Radiology Physician

General Provider Information

NPI Number	:	1972476232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY MEDICAL OF PENNSYLVANIA PC

Provider Business Mailing Address
First Line	:	135 S 19TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	135 S 19TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-4912
Country	:	US
Telephone Number	:	917-599-9655
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RICHARD DANIELS
Credential	:	MD
Telephone Number	:	732-598-4226

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	02/12/2026

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