Provider Demographics
NPI:1275648792
Name:PANDRANGI, VASU (M D)
Entity Type:Individual
Prefix:DR
First Name:VASU
Middle Name:
Last Name:PANDRANGI
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24701 EUCLID AVE
Mailing Address - Street 2:THIRD FLOOR BILLING SERVICES
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:440-816-2725
Mailing Address - Fax:440-816-2721
Practice Address - Street 1:7255 OLD OAK BLVD STE C212
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-3336
Practice Address - Country:US
Practice Address - Phone:440-816-2725
Practice Address - Fax:440-816-2721
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35045043174400000X, 208200000X
OH35-0450432086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No174400000XOther Service ProvidersSpecialist
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444291Medicaid
OH0444291Medicaid