Provider Demographics
NPI:1336363936
Name:VASCULAR INTERVENTIONS & VENOUS ASSOCIATES, LLC.
Entity Type:Organization
Organization Name:VASCULAR INTERVENTIONS & VENOUS ASSOCIATES, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DUGGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-442-9300
Mailing Address - Street 1:730 SOM CENTER RD
Mailing Address - Street 2:GEORGIAN CENTER SUITE 170
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2350
Mailing Address - Country:US
Mailing Address - Phone:440-442-9300
Mailing Address - Fax:440-442-9308
Practice Address - Street 1:730 SOM CENTER RD
Practice Address - Street 2:GEORGIAN CENTER SUITE 170
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44143-2350
Practice Address - Country:US
Practice Address - Phone:440-442-9300
Practice Address - Fax:440-442-9308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350835622086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2434539Medicaid
OH2434539Medicaid
OHH98048Medicare UPIN