Organization
VINE STREET MEDICAL AND ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARI JOHNSON (ADMIN)
(267) 292-5638
Entity
Organization
Contact information
Practice address
6323 VINE ST, PHILADELPHIA, PA 19139-1032
(267) 292-5638
(267) 292-5648
Mailing address
6323 VINE ST, PHILADELPHIA, PA 19139-1032
(267) 292-5638
(267) 292-5648
Taxonomy
Speciality
Code
Description
License number
State
207QA0401X
Addiction Medicine (Family Medicine) Physician
Primary
MD032595E
PA
Other
Enumeration date
06/08/2017
Last updated
09/11/2025
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