Basic Information
| Provider Information | |||||||||
| NPI: | 1063487783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VAISMAN | ||||||||
| FirstName: | SERGIO | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1591 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103268005 | ||||||||
| FaxNumber: | 4849450509 | ||||||||
| Practice Location | |||||||||
| Address1: | 1591 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | POTTSTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194643224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103268005 | ||||||||
| FaxNumber: | 6103279629 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 07/13/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | MD023984E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology | 207R00000X | MD023984E | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.