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General NPI Number Information
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NPI Number | 1578693966
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Entity Type | Organization
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Legal Business Name | THE VEIN CENTER OF NORTHEAST OHIO, LTD
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 04/05/2011
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Provider Practice Location Address
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Address Line | 4100 YOUNGSTOWN RD SE SUITE B
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City | WARREN
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State | OH
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Zip | 44484-3346
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Country | US
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Telephone | 330-306-0300
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Fax | 330-306-0700
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Provider Business Mailing Address
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Address Line | 4100 YOUNGSTOWN RD SE SUITE B
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City | WARREN
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State | OH
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Zip | 44484-3346
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Country | US
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Telephone | 330-306-0300
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Fax | 330-306-0700
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. RAO SUDHEENDRA
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Credential | M.D.
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Telephone | 330-306-0300
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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 | 35-039233
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License Number State | OH
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