Provider Demographics
NPI:1942009519
Name:VASCULAR SURGERY GROUP, INC.
Entity type:Organization
Organization Name:VASCULAR SURGERY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ABID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOGANNAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-347-9191
Mailing Address - Street 1:13851 E 14TH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2627
Mailing Address - Country:US
Mailing Address - Phone:510-347-9134
Mailing Address - Fax:
Practice Address - Street 1:13851 E 14TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2627
Practice Address - Country:US
Practice Address - Phone:510-357-4006
Practice Address - Fax:510-347-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty