Healthcare Provider Details

I. General information

NPI: 1134243108
Provider Name (Legal Business Name): VEIN CARE SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20826 ROUTE 19 CRANBERRY MEDICAL ARTS BLDG II
CRANBERRY TOWNSHIP PA
16066-6028
US

IV. Provider business mailing address

5011 WILLOW CREEK CT
GIBSONIA PA
15044-6117
US

V. Phone/Fax

Practice location:
  • Phone: 888-610-3974
  • Fax: 724-625-6319
Mailing address:
  • Phone: 724-625-6440
  • Fax: 724-625-6319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License NumberOS 005174L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. ANN KATHLEEN BLAKELEY
Title or Position: PRESIDENT
Credential: D.O.
Phone: 412-596-2101