Provider Demographics
NPI:1013367309
Name:VENGRENYUK, MARIYA (MD)
Entity Type:Individual
Prefix:
First Name:MARIYA
Middle Name:
Last Name:VENGRENYUK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 N 15TH ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-1101
Mailing Address - Country:US
Mailing Address - Phone:215-762-7000
Mailing Address - Fax:215-762-7765
Practice Address - Street 1:7600 CENTRAL AVE FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2442
Practice Address - Country:US
Practice Address - Phone:215-728-2276
Practice Address - Fax:215-214-4119
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX84258207R00000X
PAMD468755207R00000X
NY302324207R00000X
PAMT212010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine