Basic Information
| Provider Information | |||||||||
| NPI: | 1275548695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIENNAS | ||||||||
| FirstName: | LAMBROS | ||||||||
| MiddleName: | KONSTANTINOS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ACKERMAN RD STE 2120 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021559 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938566 | ||||||||
| FaxNumber: | 6142933381 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 ZOLLINGER RD FL 3 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432212800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142938566 | ||||||||
| FaxNumber: | 6142933381 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 04/19/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D47480 | MD | N | Other Service Providers | Specialist | 2086S0122X | 0101245217 | VA | N | Allopathic & Osteopathic Physicians | Surgery | Plastic and Reconstructive Surgery | 208200000X | 35144123 | OH | Y | Allopathic & Osteopathic Physicians | Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | CORVEL/CORCARE (EVMS HEALTH SERVICES) | OTHER | 1275548695 | 05 | VA | MEDICAID | PAR | 01 | VA | AETNA (EVMS HEALTH SERVICES) | OTHER | -019 | 01 | VA | TRICARE/CHAMPUS (EVMS HEALTH SERVICES) | OTHER | 10045252 | 01 | VA | SENTARA OPTIMA HEALTH | OTHER | 368106 | 01 | VA | ANTHEM (EVMS HEALTH SERVICES) | OTHER | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | USA MANAGED CARE (EVMS HEALTH SERVICES) | OTHER | PAR | 01 | VA | MULTIPLAN (EVMS HEALTH SERVICES) | OTHER | PAR | 01 | VA | UNITED HEALTH CARE | OTHER | PAR | 01 | VA | CIGNA (EVMS HEALTH SERVICES) | OTHER | 5911765 | 05 | NC | MEDICAID | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER |