Provider Demographics
NPI:1881747723
Name:VANISOVA, EVA T (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:T
Last Name:VANISOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 LONVALE LN
Mailing Address - Street 2:APARTMENT 126
Mailing Address - City:AMESBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01913-1967
Mailing Address - Country:US
Mailing Address - Phone:978-388-2127
Mailing Address - Fax:
Practice Address - Street 1:333 ELM ST
Practice Address - Street 2:CATARACT AND LASER CENTER
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-4530
Practice Address - Country:US
Practice Address - Phone:781-326-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA73442207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3073165Medicaid
MAB83057Medicare UPIN
MA3073165Medicaid