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General NPI Number Information
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NPI Number | 1508929365
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Entity Type | Organization
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Legal Business Name | CAROLINA VASCULAR SURGERY, LLC
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 07/26/2012
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Provider Practice Location Address
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Address Line | 1721 EBENEZER RD SUITE 115
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City | ROCK HILL
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State | SC
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Zip | 29732-4103
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Country | US
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Telephone | 803-985-4000
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Fax | 803-985-4006
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Provider Business Mailing Address
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Address Line | 1721 EBENEZER RD SUITE 115
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City | ROCK HILL
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State | SC
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Zip | 29732-4103
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Country | US
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Telephone | 803-985-4000
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Fax | 803-985-4006
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Authorized Official
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Title or Position | OWNER
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Name | MR. MARTIN VINCENT TAORMINA
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Credential | MD
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Telephone | 803-985-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 23865
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License Number State | SC
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