Provider Demographics
NPI:1346676988
Name:KAPLIN, AVIVA WALLACE (DO)
Entity Type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:WALLACE
Last Name:KAPLIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:AVIVA
Other - Middle Name:ADOLPHE
Other - Last Name:WALLACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:20 E ABINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3410
Mailing Address - Country:US
Mailing Address - Phone:323-854-5647
Mailing Address - Fax:
Practice Address - Street 1:20 E ABINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3410
Practice Address - Country:US
Practice Address - Phone:323-854-5647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-00575208600000X
VT032.0133820208600000X
PAOS019743208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery