Healthcare Provider Details

I. General information

NPI: 1265318794
Provider Name (Legal Business Name): CENTER FOR VEIN RESTORATION CT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 SAYBROOK RD STE 250
MIDDLETOWN CT
06457-4740
US

IV. Provider business mailing address

7474 GREENWAY CENTER DR STE 1000
GREENBELT MD
20770-3500
US

V. Phone/Fax

Practice location:
  • Phone: 855-830-8346
  • Fax:
Mailing address:
  • Phone: 855-830-8346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LORENA THOMAS
Title or Position: CRED MANAGER
Credential:
Phone: 815-254-1761