Provider Demographics
NPI:1144220682
Name:CORTES, VICENTE (MD)
Entity Type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:
Last Name:CORTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 N 39TH ST
Mailing Address - Street 2:TRAUMA ADMINISTRATION, B4 SOUTH
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:484-628-4888
Mailing Address - Fax:484-628-4880
Practice Address - Street 1:6TH AVENUE AND SPRUCE STREET
Practice Address - Street 2:TRAUMA ADMINISTRATION, B4 SOUTH
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:484-628-4888
Practice Address - Fax:484-628-4880
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2016-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD423741208600000X, 2086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810011017Medicaid
OH0836028Medicaid
PA1010951730001Medicaid
PAP00175800Medicare PIN
PAE75826Medicare UPIN
PA082244NJ8Medicare PIN