Provider Demographics
NPI:1568053478
Name:AIKEN VASCULAR SPECIALISTS
Entity Type:Organization
Organization Name:AIKEN VASCULAR SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GANESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PERERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-731-5720
Mailing Address - Street 1:6514 RIVER BLUFF TRL
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3318
Mailing Address - Country:US
Mailing Address - Phone:843-731-5720
Mailing Address - Fax:
Practice Address - Street 1:690 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-5385
Practice Address - Country:US
Practice Address - Phone:843-731-5720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty