Provider Demographics
NPI:1235168477
Name:V. GOSWAMI, M.D., P.C.
Entity Type:Organization
Organization Name:V. GOSWAMI, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VARDHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSWAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-949-1103
Mailing Address - Street 1:333 N OXFORD VALLEY RD
Mailing Address - Street 2:#104
Mailing Address - City:FAIRLESS HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19030-2624
Mailing Address - Country:US
Mailing Address - Phone:215-949-1103
Mailing Address - Fax:215-364-1708
Practice Address - Street 1:333 N OXFORD VALLEY RD
Practice Address - Street 2:#104
Practice Address - City:FAIRLESS HILLS
Practice Address - State:PA
Practice Address - Zip Code:19030-2624
Practice Address - Country:US
Practice Address - Phone:215-949-1103
Practice Address - Fax:215-364-1708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD066830L207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2074841001OtherINDEPENDENCE BLUE CROSS
PA1377301OtherHIGHMARK BLUE SHIELD
PA1377301OtherHIGHMARK BLUE SHIELD
PA2074841001OtherINDEPENDENCE BLUE CROSS
PA058082Medicare PIN