Provider Demographics
NPI:1578662102
Name:NORTHEAST OHIO VASCULAR ASSOCIATES, INC.
Entity Type:Organization
Organization Name:NORTHEAST OHIO VASCULAR ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-269-8346
Mailing Address - Street 1:PO BOX 1086
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44096-1086
Mailing Address - Country:US
Mailing Address - Phone:440-269-8346
Mailing Address - Fax:440-975-5763
Practice Address - Street 1:36445 BILTMORE PL STE A
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-8228
Practice Address - Country:US
Practice Address - Phone:216-645-7242
Practice Address - Fax:440-975-5763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2224248Medicaid
OHCJ2226OtherRAILROAD MEDICARE
OH=========003OtherMEDICAL MUTUAL
OH2224248Medicaid