Organization
NORTHEAST PHILADELPHIA VASCULAR SURGEONS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHITTUR R MOHAN M.D. (PRESIDENT)
(215) 969-3944
Entity
Organization
Contact information
Practice address
2000 GRANT AVE, SUITE 201, PHILADELPHIA, PA 19115-4378
(215) 969-3944
(215) 969-3886
Mailing address
2000 GRANT AVE, SUITE 201, PHILADELPHIA, PA 19115-4378
(215) 969-3944
(215) 969-3886
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000569420
BLUE SHIELD
PA
05
—
0011942860002
—
PA
01
—
0595939
AETNA
PA
01
—
0748057000
KHPE
PA
Enumeration date
07/05/2006
Last updated
11/06/2012
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