Healthcare Provider Details

I. General information

NPI: 1740956754
Provider Name (Legal Business Name): CINCINNATI ENDOVASCULAR CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 GLENDALE MILFORD RD STE 520
CINCINNATI OH
45241-3131
US

IV. Provider business mailing address

182 INDUSTRIAL RD
GLEN ROCK PA
17327-8626
US

V. Phone/Fax

Practice location:
  • Phone: 513-773-3440
  • Fax: 513-773-3439
Mailing address:
  • Phone: 717-759-5148
  • Fax: 717-759-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAYMOND FIGUEROA
Title or Position: OWNER
Credential:
Phone: 717-759-5148