Provider Demographics
NPI:1982748661
Name:VIGILANCE, DEON WARREN (MD)
Entity Type:Individual
Prefix:
First Name:DEON
Middle Name:WARREN
Last Name:VIGILANCE
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 1:1503 LANSDOWNE AVE STE 3003
Mailing Address - Street 2:
Mailing Address - City:DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19023-1308
Mailing Address - Country:US
Mailing Address - Phone:484-494-5344
Mailing Address - Fax:
Practice Address - Street 1:1503 LANSDOWNE AVE STE 3003
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1308
Practice Address - Country:US
Practice Address - Phone:484-494-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065402208G00000X
PAMD458690208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200925320Medicaid
PA103140222Medicaid
IN200925320Medicaid
IN257700LMedicare PIN
INM22404017Medicare PIN