Healthcare Provider Details

I. General information

NPI: 1023173143
Provider Name (Legal Business Name): NEIL PURSHOTTAM VACHHANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 09/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 EUCLID AVE CLEVELAND CLINIC - DEPT OF RADIOLOGY- L10
CLEVELAND OH
44195-0001
US

IV. Provider business mailing address

9500 EUCLID AVE # L10 CLEVELAND CLINIC - DEPT OF RADIOLOGY
CLEVELAND OH
44195-0001
US

V. Phone/Fax

Practice location:
  • Phone: 216-444-4778
  • Fax:
Mailing address:
  • Phone: 216-444-4778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberMD434013
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number35.093784
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number35.093784
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: