Provider Demographics
NPI:1932610755
Name:VASCULAR SURGICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:VASCULAR SURGICAL SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:V
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-430-8272
Mailing Address - Street 1:1450 E BOOT RD STE 600B
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-5968
Mailing Address - Country:US
Mailing Address - Phone:610-430-8272
Mailing Address - Fax:888-871-0040
Practice Address - Street 1:1450 E BOOT RD STE 700A
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-5962
Practice Address - Country:US
Practice Address - Phone:610-430-8272
Practice Address - Fax:888-871-0040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1034311680001Medicaid