Healthcare Provider Details

I. General information

NPI: 1750462081
Provider Name (Legal Business Name): MARYLAND AND VIRGINIA PHLEBOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 WHETSTONE WAY STE 104
BALTIMORE MD
21230-4772
US

IV. Provider business mailing address

PO BOX 971
NORTHBROOK IL
60065-0971
US

V. Phone/Fax

Practice location:
  • Phone: 410-244-8110
  • Fax:
Mailing address:
  • Phone: 847-593-8460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN AMORUSO
Title or Position: SR VP REVENUE
Credential:
Phone: 224-318-0118