Healthcare Provider Details

I. General information

NPI: 1295734275
Provider Name (Legal Business Name): VICTORIA VAN FOSSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 06/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 ARCH ST STE 280
AKRON OH
44304-1499
US

IV. Provider business mailing address

95 ARCH ST STE 280
AKRON OH
44304-1499
US

V. Phone/Fax

Practice location:
  • Phone: 330-564-2438
  • Fax: 330-564-2442
Mailing address:
  • Phone: 330-564-2438
  • Fax: 330-564-2442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35064327
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: