Healthcare Provider Details

I. General information

NPI: 1730799347
Provider Name (Legal Business Name): WARREN ENDOVASCULAR ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2020
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

330 RED ROCK RUN
CORTLAND OH
44410-9491
US

V. Phone/Fax

Practice location:
  • Phone: 330-282-6301
  • Fax: 330-451-5764
Mailing address:
  • Phone: 304-374-7754
  • Fax: 330-451-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. HEATHER M VITVITSKY
Title or Position: VICE PRESIDENT
Credential: RN
Phone: 304-374-7754