Individual
DR. VIVIANNA MAIA VAN DEERLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3400 SPRUCE STREET, 7.103 FOUNDERS PAVILLION, PHILADELPHIA, PA 19104
(215) 662-6550
(215) 662-7529
Mailing address
3400 SPRUCE ST, 7.103 FOUNDERS PAVILLION, PHILADELPHIA, PA 19104-4206
(215) 662-6550
Taxonomy
Speciality
Code
Description
License number
State
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
Primary
MD062112L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018310970001
—
PA
Enumeration date
06/15/2006
Last updated
11/30/2011
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