Healthcare Provider Details

I. General information

NPI: 1285459040
Provider Name (Legal Business Name): MOUNTAIN SPRING VASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2012 S TOLLGATE RD STE 100-102
BEL AIR MD
21015-5900
US

IV. Provider business mailing address

PO BOX 101
STEVENSON MD
21153-0101
US

V. Phone/Fax

Practice location:
  • Phone: 443-282-9424
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: SALMAN MUFTI
Title or Position: PRACTICE OWNER
Credential: MD
Phone: 888-628-8272