Individual
FABIAN A VENGOECHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7600 CENTRAL AVE, PHILADELPHIA, PA 19111-2442
(215) 728-2000
(215) 214-4119
Mailing address
257 W CAYUGA ST, PHILADELPHIA, PA 19140-2439
(267) 368-6953
(215) 621-6940
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD427681
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1007278000
MEDICAID TPI GROUP
PA
01
—
597586
MEDICARE GROUP TPI
PA
01
—
CD4829
RAIL ROAD MEDICARE GROUP TPI
PA
Enumeration date
06/10/2006
Last updated
10/11/2022
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