Individual
FREDERICK VIVINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3910 N POWELTON AVE, 2ND FLOOR, PHILADELPHIA, PA 19104-2640
(215) 662-9292
Mailing address
3910 N POWELTON AVE, 2ND FLOOR, PHILADELPHIA, PA 19104-2640
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD033113E
PA
207RR0500X
Rheumatology Physician
Primary
MD033113E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0011613830011
—
PA
Enumeration date
06/25/2006
Last updated
11/05/2012
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