Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | OS011824 | PA |
NPI | 1154361277 |
---|---|
Provider Name | Dr. Vincent M Digiovanni |
First Address | Media, PA 19063-5139 |
Second Address | Media, PA 19063-5139 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 21/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I27778 | (02) | NJ |