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General NPI Number Information
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NPI Number | 1730592353
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Entity Type | Organization
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Legal Business Name | UNITED VASCULAR & VEIN CENTER PLLC
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Dates
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Enumeration Date | 06/11/2014
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Last Update Date | 03/25/2024
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Provider Practice Location Address
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Address Line | 527 MEDICAL PARK DR STE 501
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City | BRIDGEPORT
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State | WV
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Zip | 26330
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Country | US
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Telephone | 304-842-3993
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Fax | 304-842-4083
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Provider Business Mailing Address
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Address Line | 1370 JOHNSON AVE SUITE 202
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City | BRIDGEPORT
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State | WV
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Zip | 26330-1492
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Country | US
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Telephone | 304-842-3993
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Fax | 304-842-4083
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN A ADENIYI
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Credential | MD
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Telephone | 304-842-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 21293
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License Number State | WV
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