Individual
PAUL G. VANDERVOORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
3998 RED LION RD, PHILADELPHIA, PA 19114-1436
(215) 612-4000
(215) 807-8235
Mailing address
1238 COX RD, RYDAL, PA 19046-1207
(917) 575-2151
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN546215
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3056444
AETNA CONTRACT
PA
Enumeration date
07/17/2006
Last updated
07/28/2016
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