Provider Demographics
NPI:1730592353
Name:UNITED VASCULAR & VEIN CENTER PLLC
Entity type:Organization
Organization Name:UNITED VASCULAR & VEIN CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADENIYI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-842-3993
Mailing Address - Street 1:1370 JOHNSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:BRIDGEPORT
Mailing Address - State:WV
Mailing Address - Zip Code:26330-1492
Mailing Address - Country:US
Mailing Address - Phone:304-842-3993
Mailing Address - Fax:304-842-4083
Practice Address - Street 1:527 MEDICAL PARK DR STE 501
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:WV
Practice Address - Zip Code:26330
Practice Address - Country:US
Practice Address - Phone:304-842-3993
Practice Address - Fax:304-842-4083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-11
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV212932086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty