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General NPI Number Information
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NPI Number | 1366526386
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Entity Type | Organization
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Legal Business Name | THE VEIN AND LASER CENTER OF HANOVER
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 221 POTOMAC AVE
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City | HANOVER
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State | PA
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Zip | 17331-2242
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Country | US
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Telephone | 717-637-1202
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Fax |
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Provider Business Mailing Address
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Address Line | 550 FAIRVIEW DR
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City | HANOVER
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State | PA
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Zip | 17331-9796
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Country | US
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Telephone | 717-637-8464
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. DEBORAH HARDEN
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Credential | M.B.A.
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Telephone | 717-637-1202
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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 | MD-019142-E
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License Number State | PA
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