Healthcare Provider Details

I. General information

NPI: 1780510818
Provider Name (Legal Business Name): MOUNTAIN SPRING VASCULAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 BATTLEFIELD BLVD N
CHESAPEAKE VA
23320-4735
US

IV. Provider business mailing address

PO BOX 101
STEVENSON MD
21153-0101
US

V. Phone/Fax

Practice location:
  • Phone: 844-333-8411
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: KATE GILMAN
Title or Position: COO
Credential:
Phone: 410-404-7464