Healthcare Provider Details

I. General information

NPI: 1336363936
Provider Name (Legal Business Name): VASCULAR INTERVENTIONS & VENOUS ASSOCIATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SOM CENTER RD GEORGIAN CENTER SUITE 170
CLEVELAND OH
44143-2350
US

IV. Provider business mailing address

730 SOM CENTER RD GEORGIAN CENTER SUITE 170
CLEVELAND OH
44143-2350
US

V. Phone/Fax

Practice location:
  • Phone: 440-442-9300
  • Fax: 440-442-9308
Mailing address:
  • Phone: 440-442-9300
  • Fax: 440-442-9308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number35083562
License Number StateOH

VIII. Authorized Official

Name: DR. PATRICIA ANN DUGGAN
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 440-442-9300