Provider Demographics
NPI:1528148160
Name:SAAVEDRA, CARLOS ANGEL (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:ANGEL
Last Name:SAAVEDRA
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 1:561 QUEENS CT
Mailing Address - Street 2:
Mailing Address - City:COPLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44321-3053
Mailing Address - Country:US
Mailing Address - Phone:330-666-8855
Mailing Address - Fax:330-666-8855
Practice Address - Street 1:561 QUEENS CT
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-3053
Practice Address - Country:US
Practice Address - Phone:330-666-8855
Practice Address - Fax:330-666-8855
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350420042086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0396058Medicaid
OHA77631Medicare UPIN
OHSA0449134Medicare ID - Type Unspecified