Provider Demographics
NPI:1699777102
Name:HAMPOLE, VAGESH MAHADEVAPPA (MD)
Entity type:Individual
Prefix:
First Name:VAGESH
Middle Name:MAHADEVAPPA
Last Name:HAMPOLE
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 1:125 E BROAD ST
Mailing Address - Street 2:STE 215
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6400
Mailing Address - Country:US
Mailing Address - Phone:440-329-7360
Mailing Address - Fax:440-329-7410
Practice Address - Street 1:125 E BROAD ST
Practice Address - Street 2:STE 215
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6400
Practice Address - Country:US
Practice Address - Phone:440-329-7360
Practice Address - Fax:440-329-7410
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042723207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0490633Medicaid
OH3041765Medicaid
OH0514238Medicare PIN
OH0514236Medicare PIN
OH0490633Medicaid