Provider Demographics
NPI:1801866751
Name:IVANAUSKAS, SAULIUS (MD)
Entity type:Individual
Prefix:
First Name:SAULIUS
Middle Name:
Last Name:IVANAUSKAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6476 SCIOTO CT
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-8400
Mailing Address - Country:US
Mailing Address - Phone:614-370-2163
Mailing Address - Fax:
Practice Address - Street 1:6476 SCIOTO CT
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-8400
Practice Address - Country:US
Practice Address - Phone:614-891-8453
Practice Address - Fax:614-891-8453
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-6541-I207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000315923OtherBCBS FOR HOCKING VALLEY
OH2147822Medicaid
OHP00120015OtherRRMEDICARE FOR BERGER
OH000000316753OtherBCBS FOR BERGER
OH5619197341C1DOtherBLUECROSS BLUESHIELD
OHP00156475OtherRRMEDICARE FOR HOCKING
OH000000543478OtherBCBS FOR FAYETTE
OH000000316753OtherBCBS FOR BERGER
OH000000543478OtherBCBS FOR FAYETTE
OH4023959Medicare PIN
OH4136632Medicare PIN
OH2147822Medicaid
OH4136638Medicare PIN
OH000000315923OtherBCBS FOR HOCKING VALLEY