Provider Demographics
NPI:1558578047
Name:VANZANT, KRISTIN MARIA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:MARIA
Last Name:VANZANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 S 30TH ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-3403
Mailing Address - Country:US
Mailing Address - Phone:215-386-3838
Mailing Address - Fax:215-438-4872
Practice Address - Street 1:120 S 30TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-3403
Practice Address - Country:US
Practice Address - Phone:215-386-3838
Practice Address - Fax:215-438-4872
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD043067E2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA00698250Medicare ID - Type UnspecifiedMEDICARE