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General NPI Number Information
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NPI Number | 1194354274
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Entity Type | Organization
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Legal Business Name | CENTER FOR VASCULAR MEDICINE IN LLC
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Dates
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Enumeration Date | 04/02/2020
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 33 E COUNTY LINE RD STE D
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City | GREENWOOD
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State | IN
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Zip | 46143-1078
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Country | US
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Telephone | 301-486-4690
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Fax |
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Provider Business Mailing Address
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Address Line | 7474 GREENWAY CENTER DR STE 900
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City | GREENBELT
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State | MD
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Zip | 20770-3504
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Country | US
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Telephone | 301-982-2000
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Fax | 301-982-2001
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | RICHARD KENNEDY
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Credential | PA-C
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Telephone | 301-982-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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