1417129354 NPI number — VINAY VERMANI, M.D., DBA TRI-STATE CANCER AND BLOOD SPECIALIST

Table of content: (NPI 1417129354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417129354 NPI number — VINAY VERMANI, M.D., DBA TRI-STATE CANCER AND BLOOD SPECIALIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VINAY VERMANI, M.D., DBA TRI-STATE CANCER AND BLOOD SPECIALIST
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1417129354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 VALLEY DR
Provider Second Line Business Mailing Address:
SUITE 15
Provider Business Mailing Address City Name:
PT PLEASANT
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25550-2031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-675-1759
Provider Business Mailing Address Fax Number:
304-675-2607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2301 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2873
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-3333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VERMANI
Authorized Official First Name:
VINAY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
606-324-3333

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2639596 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".