Healthcare Provider Details

I. General information

NPI: 1518984418
Provider Name (Legal Business Name): VEIN CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 ADLEY WAY
GREENVILLE SC
29607-6511
US

IV. Provider business mailing address

P O BOX 65169
CHARLOTTE NC
28265-5169
US

V. Phone/Fax

Practice location:
  • Phone: 864-297-1244
  • Fax: 864-297-1277
Mailing address:
  • Phone: 803-808-8070
  • Fax: 803-808-8074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID GERALD STONE
Title or Position: PHYSICIAN
Credential: MD
Phone: 864-297-1244