Provider Demographics
NPI:1417031170
Name:VAGAONESCU, TUDOR D (MD)
Entity Type:Individual
Prefix:
First Name:TUDOR
Middle Name:D
Last Name:VAGAONESCU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:REDBANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:125 PATERSON ST
Practice Address - Street 2:5TH FLOOR SUITE 5200
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-1962
Practice Address - Country:US
Practice Address - Phone:732-235-6561
Practice Address - Fax:732-235-6530
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA06930100207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00232117OtherRR MCR PTAN
NJ780222259OtherHORIZON
NJ9395990OtherPHCS
NJP00145537OtherRAILROAD MEDICARE
NJP3604520OtherOXFORD
NJ1973429OtherCIGNA
NJ40700OtherUNIVERSITY HEALTH PLAN
NJ7269408OtherAETNA
NJ8357901Medicaid
NJ043642Medicare ID - Type Unspecified
NJ40700OtherUNIVERSITY HEALTH PLAN