Individual
VIJAY KANGOTRA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 S 11TH ST, SUITE 8490, PHILADELPHIA, PA 19107-4824
(215) 955-2370
Mailing address
4551 STRUTFIELD LN, APT # 4220, ALEXANDRIA, VA 22311-4967
(703) 575-8194
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
0101249313
VA
207LP3000X
Pediatric Anesthesiology Physician
MT189631
PA
Other
Enumeration date
05/14/2007
Last updated
07/08/2020
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