Most Relevant Information
Provider Data
| NPI Number: | 1003481391 |
| Provider Name: | TANYA MARIE VIGDAL OD |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 05/20/2021 |
| Last Updated: | 08/24/2021 |
Provider Practice Location
841 E BALTIMORE PIKE
KENNETT SQUARE
PA
193481801
Practice Location Phone/Fax
| Phone: | 6104445252 |
| Fax: |
Provider Mailing Location
1950 OLD GALLOWS RD STE 520
VIENNA
VA
221823970
Provider Mailing Phone/Fax
| Phone: | 7038478899 |
| Fax: | 5712236780 |