Provider Demographics
NPI:1699035469
Name:VANGORDEN, TEORINA (RD)
Entity Type:Individual
Prefix:
First Name:TEORINA
Middle Name:
Last Name:VANGORDEN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3335
Mailing Address - Country:US
Mailing Address - Phone:610-372-8044
Mailing Address - Fax:484-334-7026
Practice Address - Street 1:2603 KEISER BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-3341
Practice Address - Country:US
Practice Address - Phone:610-988-5673
Practice Address - Fax:610-568-3139
Is Sole Proprietor?:No
Enumeration Date:2012-05-25
Last Update Date:2012-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered