Provider Demographics
NPI:1518064245
Name:CATHERINE A VLASTARIS UNDERMAN MD INC
Entity Type:Organization
Organization Name:CATHERINE A VLASTARIS UNDERMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:VLASTARIS UNDERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-333-6444
Mailing Address - Street 1:PO BOX 450856
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0619
Mailing Address - Country:US
Mailing Address - Phone:440-808-3700
Mailing Address - Fax:440-808-3675
Practice Address - Street 1:20455 LORAIN RD
Practice Address - Street 2:SUITE 304
Practice Address - City:FAIRVIEW PARK
Practice Address - State:OH
Practice Address - Zip Code:44126-3531
Practice Address - Country:US
Practice Address - Phone:440-333-6444
Practice Address - Fax:440-333-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-17
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDA3608OtherRRCARE
OHDA3608OtherRRCARE