Provider Demographics
NPI:1346259876
Name:DANIEL J VILE DO PC
Entity Type:Organization
Organization Name:DANIEL J VILE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:VILE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-969-7510
Mailing Address - Street 1:PO BOX 16335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-0435
Mailing Address - Country:US
Mailing Address - Phone:215-969-7510
Mailing Address - Fax:215-969-7513
Practice Address - Street 1:9501 ROOSEVELT BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1029
Practice Address - Country:US
Practice Address - Phone:215-969-7510
Practice Address - Fax:215-969-7513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS006269L207R00000X, 207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028248OtherKEYSTONE MERCY
PA5618455OtherAETNA/USHC
PA712838OtherBLUE SHIELD
PA0549116000OtherKEYSTONE
PA0549116000OtherAMERI HEALTH
PA5491235OtherCIGNA
PA0014125700004Medicaid
PA060052271OtherTRAVELERS MC
PA24078OtherHEALTH PARTNERS
PA1028248OtherKEYSTONE MERCY
PA104234Medicare PIN