Individual
RAYMOND J VIVACQUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 MEDICAL CENTER BLVD, VIVACQUA PAVILION SUITE 341, UPLAND, PA 19013-3902
(610) 619-7420
(610) 876-6923
Mailing address
131 PADDOCK LN, MEDIA, PA 19063-1109
(610) 619-7420
(610) 876-6923
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
25MA07633500
NJ
207RH0003X
Hematology & Oncology Physician
C10009188
DE
207RH0003X
Hematology & Oncology Physician
MD027985L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000661297-0002
—
PA
Enumeration date
11/03/2005
Last updated
07/10/2012
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