Provider Demographics
NPI:1548597164
Name:PHILADELPHIA VASCULAR INSTITUTE LLC
Entity Type:Organization
Organization Name:PHILADELPHIA VASCULAR INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:F
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-382-3680
Mailing Address - Street 1:2929 ARCH ST
Mailing Address - Street 2:SUITE 620
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2866
Mailing Address - Country:US
Mailing Address - Phone:215-382-3680
Mailing Address - Fax:215-382-3683
Practice Address - Street 1:4622 BLACK HORSE PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-3214
Practice Address - Country:US
Practice Address - Phone:215-382-3680
Practice Address - Fax:215-382-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty