Healthcare Provider Details

I. General information

NPI: 1033530092
Provider Name (Legal Business Name): CAROLINA VEIN ASSOCIATES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2013
Last Update Date: 06/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 JOE V. KNOX AVENUE SUITE H
MOORESVILLE NC
28117-7912
US

IV. Provider business mailing address

206 JOE V. KNOX AVENUE SUITE H
MOORESVILLE NC
28117-7912
US

V. Phone/Fax

Practice location:
  • Phone: 704-798-7251
  • Fax:
Mailing address:
  • Phone: 704-798-7251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TODD R HANSEN
Title or Position: PARTNER
Credential: MD
Phone: 704-798-7251