Provider Demographics
NPI:1659397438
Name:VANBUREN, GEORGE A (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:A
Last Name:VANBUREN
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 1:24701 EUCLID AVE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117-1714
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1716
Practice Address - Country:US
Practice Address - Phone:216-844-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056164207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021535110001OtherPA MEDICAID
OH0803410Medicaid
OH364091OtherWELLCARE
OH000000221247OtherUNISON
OH738111OtherBUCKEYE
OH000000509186OtherANTHEM
OH160058360OtherRAILROAD MEDICARE
OH4301839OtherAETNA
OH000000221247OtherUNISON
A14369Medicare UPIN
OHVA4010814Medicare PIN