Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD030941E | PA |
N | 111NI0900X | Internist | MD030941E | PA |
Y | 207RC0000X | Internist - Cardiovascular Disease | MD030941E | PA |
NPI | 1013947167 |
---|---|
Provider Name | Gary J Vigilante |
First Address | Philadelphia, PA 19104-2640 |
Second Address | Philadelphia, PA 19104-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/07/2006 |
Last Update Date | 19/06/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0010479600012 | (05) | PA |
B41166 | (02) |