Provider Demographics
NPI:1013173764
Name:VASCULAR AND VEIN CENTER PA
Entity Type:Organization
Organization Name:VASCULAR AND VEIN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND VASCULAR SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:PALADUGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-332-8346
Mailing Address - Street 1:PO BOX 33434
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76162-3434
Mailing Address - Country:US
Mailing Address - Phone:817-332-8346
Mailing Address - Fax:817-332-1723
Practice Address - Street 1:851 W TERRELL AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3161
Practice Address - Country:US
Practice Address - Phone:817-332-8346
Practice Address - Fax:817-332-1723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL 95842086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z839Medicare PIN