Provider Demographics
NPI:1295953719
Name:ADVANCED VEIN & VASCULAR CENTER, INC.
Entity type:Organization
Organization Name:ADVANCED VEIN & VASCULAR CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:CARABASI
Authorized Official - Suffix:III
Authorized Official - Credentials:M D
Authorized Official - Phone:610-687-5347
Mailing Address - Street 1:744 W LANCASTER AVE
Mailing Address - Street 2:SUITE 225, DEVON SQUARE II
Mailing Address - City:WAYNE
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2523
Mailing Address - Country:US
Mailing Address - Phone:610-687-5347
Mailing Address - Fax:610-933-8104
Practice Address - Street 1:744 W LANCASTER AVE
Practice Address - Street 2:SUITE 225, DEVON SQUARE II
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2523
Practice Address - Country:US
Practice Address - Phone:610-687-5347
Practice Address - Fax:610-933-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-22
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022004E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty