Basic Information
| Provider Information | |||||||||
| NPI: | 1609085448 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHAS | ||||||||
| FirstName: | VIJILADEVI | ||||||||
| MiddleName: | PERSIS | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 SANSOM ST STE 239 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191075002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556844 | ||||||||
| FaxNumber: | 2159552526 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 SANSOM ST | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159556844 | ||||||||
| FaxNumber: | 2159552526 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 222256 | MA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301094431 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207R00000X | 4301094431 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 222256 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207P00000X | MD452038 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.