Provider Demographics
NPI:1396118147
Name:PVD MEDICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:PVD MEDICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DELDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-445-4450
Mailing Address - Street 1:PO BOX 690804
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78269-0804
Mailing Address - Country:US
Mailing Address - Phone:210-564-9790
Mailing Address - Fax:210-564-9741
Practice Address - Street 1:18007 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9536
Practice Address - Country:US
Practice Address - Phone:210-530-1040
Practice Address - Fax:210-530-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-02
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty