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General NPI Number Information
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NPI Number | 1295953719
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Entity Type | Organization
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Legal Business Name | ADVANCED VEIN & VASCULAR CENTER, INC.
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Dates
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Enumeration Date | 04/22/2007
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 744 W LANCASTER AVE SUITE 225, DEVON SQUARE II
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City | WAYNE
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State | PA
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Zip | 19087-2523
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Country | US
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Telephone | 610-687-5347
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Fax | 610-933-8104
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Provider Business Mailing Address
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Address Line | 744 W LANCASTER AVE SUITE 225, DEVON SQUARE II
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City | WAYNE
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State | PA
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Zip | 19087-2523
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Country | US
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Telephone | 610-687-5347
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Fax | 610-933-8104
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Authorized Official
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Title or Position | PRESIDENT & MEDICAL DIRECTOR
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Name | DR. RALPH ANTHONY CARABASI III
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Credential | M. D.
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Telephone | 610-687-5347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD022004E
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License Number State | PA
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