Healthcare Provider Details

I. General information

NPI: 1306172309
Provider Name (Legal Business Name): VEIN AND WELLNESS GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2009
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 DEFENSE HWY STE 101
ANNAPOLIS MD
21401-8921
US

IV. Provider business mailing address

166 DEFENSE HWY STE 101
ANNAPOLIS MD
21401-8921
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-3390
  • Fax: 410-224-3370
Mailing address:
  • Phone: 410-224-3390
  • Fax: 410-224-3370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberD0042645
License Number StateMD

VIII. Authorized Official

Name: DR. KELLY ANN O'DONNELL
Title or Position: OWNER
Credential: M.D.
Phone: 410-693-3161