Provider Demographics
NPI:1871757559
Name:TRISTATE VEIN CENTERS LLC
Entity type:Organization
Organization Name:TRISTATE VEIN CENTERS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:FARZIN
Authorized Official - Middle Name:
Authorized Official - Last Name:FORUHARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-662-8346
Mailing Address - Street 1:3006 GLENMORE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-2203
Mailing Address - Country:US
Mailing Address - Phone:513-662-8346
Mailing Address - Fax:513-662-0033
Practice Address - Street 1:3006 GLENMORE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-2203
Practice Address - Country:US
Practice Address - Phone:513-662-8346
Practice Address - Fax:513-662-0033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35083656261QM2500X
OH35077989261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty