Provider Demographics
NPI:1972826584
Name:ADDIS, VICTORIA MARIE (MD)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:MARIE
Last Name:ADDIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3801 FILBERT ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-2640
Mailing Address - Country:US
Mailing Address - Phone:215-662-8100
Mailing Address - Fax:215-662-1721
Practice Address - Street 1:3801 FILBERT ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-2640
Practice Address - Country:US
Practice Address - Phone:215-662-8100
Practice Address - Fax:215-662-1721
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD454099207WX0009X
MI4301104483207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Yes207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist