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General NPI Number Information
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NPI Number | 1093688087
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Entity Type | Organization
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Legal Business Name | VASCULAR SPECIALTY SERVICES, LLC
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Dates
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Enumeration Date | 09/25/2025
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 114 BUSINESS CENTER DR
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City | REISTERSTOWN
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State | MD
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Zip | 21136-1229
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Country | US
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Telephone | 410-332-9404
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Fax | 410-347-5599
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Provider Business Mailing Address
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Address Line | 301 ST PAUL PLACE MEDICAL STAFF OFFICE
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City | BALTIMORE
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State | MD
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Zip | 21202-2102
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Country | US
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Telephone | 410-659-2963
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Fax | 410-332-9789
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Authorized Official
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Title or Position | EXECUTIVE VICE PRESIDENT/CFO
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Name | JUSTIN DEIBEL
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Credential |
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Telephone | 410-659-2905
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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