Provider Demographics
NPI:1578507299
Name:VITVITSKY, EUGENE VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:VICTOR
Last Name:VITVITSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 NILES CORTLAND RD NE STE 12
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-1077
Mailing Address - Country:US
Mailing Address - Phone:330-282-6301
Mailing Address - Fax:330-451-5764
Practice Address - Street 1:1950 NILES CORTLAND RD NE STE 12
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-1077
Practice Address - Country:US
Practice Address - Phone:330-282-6301
Practice Address - Fax:330-451-5764
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35082483208G00000X
AZ35142208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0143870Medicaid