Provider Demographics
NPI:1376958686
Name:VASCULAR CENTER PA
Entity Type:Organization
Organization Name:VASCULAR CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ASHISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-338-9444
Mailing Address - Street 1:620 STANTON CHRISTIANA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2133
Mailing Address - Country:US
Mailing Address - Phone:302-338-9444
Mailing Address - Fax:302-994-9449
Practice Address - Street 1:620 STANTON CHRISTIANA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2133
Practice Address - Country:US
Practice Address - Phone:302-338-9444
Practice Address - Fax:302-994-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-25
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10005636174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1649247487Medicaid