Provider Demographics
NPI:1609275478
Name:THORACIC & VASCULAR SURGICAL SPECIALTY SERVICES
Entity Type:Organization
Organization Name:THORACIC & VASCULAR SURGICAL SPECIALTY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CIMENGA
Authorized Official - Middle Name:M
Authorized Official - Last Name:TSHIBAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-676-6505
Mailing Address - Street 1:20 EXPEDITION TRL
Mailing Address - Street 2:SUITE 110B
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-8598
Mailing Address - Country:US
Mailing Address - Phone:443-676-6505
Mailing Address - Fax:
Practice Address - Street 1:20 EXPEDITION TRL
Practice Address - Street 2:SUITE 110B
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-8598
Practice Address - Country:US
Practice Address - Phone:443-676-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418715174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty