Healthcare Provider Details

I. General information

NPI: 1437527181
Provider Name (Legal Business Name): OHIO ENDOVASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 NILES CORTLAND RD NE STE 12
WARREN OH
44484-1077
US

IV. Provider business mailing address

1950 NILES CORTLAND RD NE STE 12
WARREN OH
44484-1077
US

V. Phone/Fax

Practice location:
  • Phone: 330-282-6301
  • Fax: 330-362-4169
Mailing address:
  • Phone: 304-374-7754
  • Fax: 330-362-4169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number35082483
License Number StateOH

VIII. Authorized Official

Name: DR. EUGENE V. VITVITSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 330-282-6301