Healthcare Provider Details

I. General information

NPI: 1407803042
Provider Name (Legal Business Name): CATHERINE A VLASTARIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 03/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33100 CLEVELAND CLINIC BLVD - AVW3-2 CLEVELAND CLINIC RICHARD E JACOBS HEALTH CENTER
AVON OH
44011
US

IV. Provider business mailing address

33100 CLEVELAND CLINIC BLVD - AVW3-2 CLEVELAND CLINIC RICHARD E JACOBS HEALTH CENTER
AVON OH
44011
US

V. Phone/Fax

Practice location:
  • Phone: 440-695-4000
  • Fax: 440-695-4389
Mailing address:
  • Phone: 440-695-4000
  • Fax: 440-695-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35064822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: