Provider Demographics
NPI:1366455123
Name:VASCULAR CONSULTANTS PA
Entity Type:Organization
Organization Name:VASCULAR CONSULTANTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHICKLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-733-5312
Mailing Address - Street 1:4765 OGLETOWN STANTON RD
Mailing Address - Street 2:SUITE 1E20
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-8003
Mailing Address - Country:US
Mailing Address - Phone:302-733-5700
Mailing Address - Fax:302-733-5775
Practice Address - Street 1:4765 OGLETOWN STANTON RD
Practice Address - Street 2:SUITE 1E20
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-8003
Practice Address - Country:US
Practice Address - Phone:302-733-5700
Practice Address - Fax:302-733-5775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE19890322712086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0679229000OtherDELAWARE VALLEY HMO
DE0000154702Medicaid
PA0679229000OtherBLUE CROSS
0094592OtherUS HEALTH CARE
DE454028Medicare ID - Type Unspecified