Individual
JAMES VANDENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5103
(215) 707-5030
Mailing address
847 N WOODSTOCK ST, PHILADELPHIA, PA 19130-1439
(616) 460-1181
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
TMD004841
PA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/12/2017
Last updated
07/07/2020
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