Provider Demographics
NPI:1346438751
Name:VASCULAR MEDICINE & SURGICAL ASSOCIATES, LLP
Entity Type:Organization
Organization Name:VASCULAR MEDICINE & SURGICAL ASSOCIATES, LLP
Other - Org Name:KOLLIPARA & KOLLIPARA
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATA
Authorized Official - Middle Name:S
Authorized Official - Last Name:KOLLIPARA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-747-1106
Mailing Address - Street 1:540 PARMALEE AVE
Mailing Address - Street 2:410
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44510-1716
Mailing Address - Country:US
Mailing Address - Phone:330-747-1106
Mailing Address - Fax:330-747-0491
Practice Address - Street 1:540 PARMALEE AVE
Practice Address - Street 2:410
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44510-1716
Practice Address - Country:US
Practice Address - Phone:330-747-1106
Practice Address - Fax:330-747-0491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-10
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-046028174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0589368Medicaid
OHDA9406OtherRAILROAD MEDICARE
OH9335121Medicare PIN