Provider Demographics
NPI:1447474085
Name:SHANI VATURI MD LLC
Entity type:Organization
Organization Name:SHANI VATURI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHANI
Authorized Official - Middle Name:
Authorized Official - Last Name:VATURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-448-3060
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0208
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7264 WARREN SHARON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403-9665
Practice Address - Country:US
Practice Address - Phone:330-448-3060
Practice Address - Fax:330-448-2555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35062216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014975420002Medicaid
OH0930103Medicaid
PA0014975420002Medicaid
OH9334501Medicare PIN
PA070541Medicare PIN