Provider Demographics
NPI:1164690327
Name:VERSHVOVSKY, FELIX (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:
Last Name:VERSHVOVSKY
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:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9010
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:2100 W GIRARD AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19130-1400
Practice Address - Country:US
Practice Address - Phone:215-685-0800
Practice Address - Fax:215-685-0846
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY247248207Q00000X
PAMD-433799207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00633382OtherRAILROAD MEDICARE
PA597586OtherMEDICARE GROUP
PACD4829OtherRR MEDICARE
PA102202545Medicaid
PAP00633382OtherRAILROAD MEDICARE