MEDICARE: DR. MAYURI RAJU VEGASANA M.D

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	208000000X	Pediatrics Physician	35.125763	OH

General Provider Information

NPI Number	:	1720392681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAYURI RAJU VEGASANA M.D

Provider Business Mailing Address
First Line	:	1 PERKINS SQ
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44308-1063
Country	:	US
Telephone Number	:	330-253-4931
Fax Number	:	330-253-8619

Provider Business Practice Location Address
First Line	:	1463 CANTON RD STE A
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44312-4022
Country	:	US
Telephone Number	:	330-253-4931
Fax Number	:	330-253-8619

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

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	01/10/2022

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