Provider Demographics
NPI:1215407218
Name:VASCULAR AND ENDOVASCULAR SURGERY, PC
Entity Type:Organization
Organization Name:VASCULAR AND ENDOVASCULAR SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ABID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOGANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-899-8272
Mailing Address - Street 1:1900 CAMDEN AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2944
Mailing Address - Country:US
Mailing Address - Phone:408-558-3600
Mailing Address - Fax:408-614-2001
Practice Address - Street 1:2505 SAMARITAN DR STE 503
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4015
Practice Address - Country:US
Practice Address - Phone:408-558-3600
Practice Address - Fax:408-614-2001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty