Provider Demographics
NPI:1598966707
Name:VASU, NEETU B (MD)
Entity Type:Individual
Prefix:DR
First Name:NEETU
Middle Name:B
Last Name:VASU
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 1:255 S 17TH ST STE 1104
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6212
Mailing Address - Country:US
Mailing Address - Phone:215-515-5999
Mailing Address - Fax:215-545-1384
Practice Address - Street 1:255 S 17TH ST STE 1104
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6212
Practice Address - Country:US
Practice Address - Phone:215-515-5999
Practice Address - Fax:215-545-1384
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10664500207KA0200X
PAMD468870207KA0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0074868OtherMD LICENSE