MEDICARE: DR. EUGENE VICTOR VITVITSKY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	35082483	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578507299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE VICTOR VITVITSKY MD

Provider Business Mailing Address
First Line	:	1950 NILES CORTLAND RD NE STE 12
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1077
Country	:	US
Telephone Number	:	330-282-6301
Fax Number	:	330-451-5764

Provider Business Practice Location Address
First Line	:	1950 NILES CORTLAND RD NE STE 12
Second Line	:
City	:	WARREN
State	:	OH
Zip	:	44484-1077
Country	:	US
Telephone Number	:	330-282-6301
Fax Number	:	330-451-5764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	08/22/2023

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