Healthcare Provider Details

I. General information

NPI: 1528051471
Provider Name (Legal Business Name): JOHN OVID VLAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2219 E MARKET ST
WARREN OH
44483-6105
US

IV. Provider business mailing address

2219 E MARKET ST
WARREN OH
44483-6105
US

V. Phone/Fax

Practice location:
  • Phone: 330-841-7332
  • Fax: 330-841-7329
Mailing address:
  • Phone: 330-841-7332
  • Fax: 330-841-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35024361V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: