Provider Demographics
NPI:1407803042
Name:VLASTARIS, CATHERINE A (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:A
Last Name:VLASTARIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33100 CLEVELAND CLINIC BLVD - AVW3-2
Mailing Address - Street 2:CLEVELAND CLINIC RICHARD E JACOBS HEALTH CENTER
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011
Mailing Address - Country:US
Mailing Address - Phone:440-695-4000
Mailing Address - Fax:440-695-4389
Practice Address - Street 1:33100 CLEVELAND CLINIC BLVD - AVW3-2
Practice Address - Street 2:CLEVELAND CLINIC RICHARD E JACOBS HEALTH CENTER
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011
Practice Address - Country:US
Practice Address - Phone:440-695-4000
Practice Address - Fax:440-695-4389
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-28
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35064822207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2091525Medicaid
OH070017531OtherRAILROAD MEDICARE
OH2091525Medicaid
OH0839452Medicare PIN