Healthcare Provider Details

I. General information

NPI: 1255430864
Provider Name (Legal Business Name): VIRGINIA VATEV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 CLAGUE RD STE 3201
WESTLAKE OH
44145-1588
US

IV. Provider business mailing address

PO BOX 901543
CLEVELAND OH
44190-1543
US

V. Phone/Fax

Practice location:
  • Phone: 216-383-0100
  • Fax: 216-383-6481
Mailing address:
  • Phone: 440-250-2070
  • Fax: 440-250-2071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35061518
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35061518V
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: