Provider Demographics
NPI:1578772893
Name:VITEBSKIY, SERGEY A (MD)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:A
Last Name:VITEBSKIY
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 1:224 W EXCHANGE ST
Mailing Address - Street 2:#225
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1704
Mailing Address - Country:US
Mailing Address - Phone:330-344-4377
Mailing Address - Fax:330-761-2492
Practice Address - Street 1:224 W EXCHANGE ST
Practice Address - Street 2:#225
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1704
Practice Address - Country:US
Practice Address - Phone:330-344-4377
Practice Address - Fax:330-761-2492
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085221207RC0000X
OH35-085221207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2957886OtherHEART RHYTHM ASSOCIATES MEDICAID GROUP #
OH9384101OtherHEART RHYTHM ASSOCIATES MEDICARE GROUP #
OH1568632628OtherHEART RHYTHM ASSOCIATES TYPE 2 NPI #
OH2648433Medicaid
OHH002720Medicare PIN