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General NPI Number Information
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NPI Number | 1316222177
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Entity Type | Organization
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Legal Business Name | VEIN HEALTH CENTER OF MARYLAND
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Dates
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Enumeration Date | 10/12/2011
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Last Update Date | 10/12/2011
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Provider Practice Location Address
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Address Line | 12013 BROAD MEADOW LN
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City | CLARKSVILLE
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State | MD
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Zip | 21029-1258
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Country | US
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Telephone | 443-253-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 9801 GEORGIA AVE SUITE 118
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City | SILVER SPRING
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State | MD
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Zip | 20902-5276
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Country | US
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Telephone | 301-686-8555
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Fax | 301-593-9055
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | ASHA VALI
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Credential | M.D.
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Telephone | 443-280-0255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | D0052861
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License Number State | MD
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