Provider Demographics
NPI:1265196711
Name:TVCG UM PLLC
Entity type:Organization
Organization Name:TVCG UM PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GORIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-775-1984
Mailing Address - Street 1:21 EASTERN AVE
Mailing Address - Street 2:FL 3
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3094
Mailing Address - Country:US
Mailing Address - Phone:508-556-0223
Mailing Address - Fax:
Practice Address - Street 1:21 EASTERN AVE FL 3
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3094
Practice Address - Country:US
Practice Address - Phone:508-556-0223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty