Healthcare Provider Details

I. General information

NPI: 1518452010
Provider Name (Legal Business Name): ENDOVASCULAR ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2018
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8790 E MARKET ST STE 300
WARREN OH
44484-2360
US

IV. Provider business mailing address

3001 PALM HARBOR BLVD STE A
PALM HARBOR FL
34683-1930
US

V. Phone/Fax

Practice location:
  • Phone: 330-282-6301
  • Fax: 330-362-4169
Mailing address:
  • Phone: 727-214-0462
  • Fax: 727-474-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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