Provider Demographics
NPI:1255315222
Name:VRAHAS, MARK STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:VRAHAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 S SAN VICENTE BLVD STE 603
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4178
Mailing Address - Country:US
Mailing Address - Phone:310-423-5877
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 603
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4178
Practice Address - Country:US
Practice Address - Phone:310-423-5877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160413207X00000X
CAG145660207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA401688OtherTUFTS HEALTH PLAN
MA3198651Medicaid
MAJ21515OtherBCBS MA
MAJ21515OtherBCBS MA
E59862Medicare UPIN