Provider Demographics
NPI:1437241270
Name:MELBOURNE VASCULAR & ENDOVASCULAR CENTER PA
Entity Type:Organization
Organization Name:MELBOURNE VASCULAR & ENDOVASCULAR CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAMADAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-725-8919
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32902-0146
Mailing Address - Country:US
Mailing Address - Phone:321-725-8919
Mailing Address - Fax:321-725-8854
Practice Address - Street 1:1250 S HARBOR CITY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3242
Practice Address - Country:US
Practice Address - Phone:321-725-8919
Practice Address - Fax:321-725-8854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1730178641OtherFUAD RAMADAN'S INDIV NPI
FL274247100Medicaid
FL1730178641OtherFUAD RAMADAN'S INDIV NPI
C89427Medicare UPIN