Provider Demographics
NPI:1427019959
Name:VASSILAROS, MARIA SARMA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:SARMA
Last Name:VASSILAROS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3726 TIPPECANOE PL
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9068
Mailing Address - Country:US
Mailing Address - Phone:330-533-6402
Mailing Address - Fax:330-533-3183
Practice Address - Street 1:527 N MERIDIAN RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-1227
Practice Address - Country:US
Practice Address - Phone:330-797-0074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-02
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35056622207R00000X
OH35.056622207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1427019959Medicaid
OHE76646Medicare UPIN