Provider Demographics
NPI:1689651804
Name:VANGAALEN, ADRIAAN JOHAN (MD)
Entity Type:Individual
Prefix:
First Name:ADRIAAN
Middle Name:JOHAN
Last Name:VANGAALEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:STE 203
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1155
Mailing Address - Country:US
Mailing Address - Phone:610-691-3603
Mailing Address - Fax:610-861-8104
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:STE 203
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1155
Practice Address - Country:US
Practice Address - Phone:610-691-3603
Practice Address - Fax:610-861-8104
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039195L207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01233801OtherBC
PAVA133383OtherBS
PAVA133383OtherBS
PA01233801OtherBC