Provider Demographics
NPI:1578693966
Name:THE VEIN CENTER OF NORTHEAST OHIO, LTD
Entity Type:Organization
Organization Name:THE VEIN CENTER OF NORTHEAST OHIO, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAO
Authorized Official - Middle Name:
Authorized Official - Last Name:SUDHEENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-306-0300
Mailing Address - Street 1:4100 YOUNGSTOWN RD SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44484-3346
Mailing Address - Country:US
Mailing Address - Phone:330-306-0300
Mailing Address - Fax:330-306-0700
Practice Address - Street 1:4100 YOUNGSTOWN RD SE
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44484-3346
Practice Address - Country:US
Practice Address - Phone:330-306-0300
Practice Address - Fax:330-306-0700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-039233174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHC01284Medicare UPIN