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Organization
CLINICAL NEPHROLOGY ASSOC INC PC
Active
Organization
CLINICAL NEPHROLOGY ASSOC INC PC
Active
Other names
Metro Vascular Center
Organization subpart
No
Provider details
NPI number
Authorized official
MS. JENNIFER MAXIMENKO MHA, RT (FACILITY ADMINISTRATOR)
(215) 568-6822
Entity
Organization
Contact information
Practice address
235 N BROAD ST, SUITE 100, PHILADELPHIA, PA 19107
(215) 568-6822
(215) 568-6833
Mailing address
235 N BROAD ST, SUITE 100, PHILADELPHIA, PA 19107-1511
(215) 568-6822
(215) 568-6833
Taxonomy
Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
22381501
PA
207RN0300X
Nephrology Physician
—
NULL
207RN0300X
Nephrology Physician
—
—
2085R0204X
Vascular & Interventional Radiology Physician
22381501
PA
2086S0129X
Vascular Surgery Physician
22381501
PA
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
NULL
Other
Enumeration date
02/02/2017
Last updated
07/25/2018
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