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Organization

PROGRESSIVE PHYSICIAN ASSOC INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
SUSANNE DEANGELO (ADMINISTRATIVE CREDENTIALING COORDI)
(610) 868-1100
Entity
Organization

Contact information

Practice address
95 HIGHLAND AVE, SUITE 130, BETHLEHEM, PA 18017-9424
(610) 868-1100
(610) 868-1111
Mailing address
95 HIGHLAND AVE, SUITE 130, BETHLEHEM, PA 18017-9424
(610) 868-1100
(610) 868-1111

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
PA
2085R0204X
Vascular & Interventional Radiology Physician
PA
2086S0129X
Vascular Surgery Physician
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1303700
PA
Enumeration date
05/17/2006
Last updated
12/16/2022
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