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General NPI Number Information
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NPI Number | 1518552447
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Entity Type | Organization
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Legal Business Name | CENTER FOR VASCULAR MEDICINE AL LLC
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Dates
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Enumeration Date | 03/03/2021
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Last Update Date | 03/03/2021
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Provider Practice Location Address
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Address Line | 3280 ROSS CLARK CIR
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City | DOTHAN
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State | AL
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Zip | 36303-3040
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Country | US
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Telephone | 301-486-4690
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Fax | 301-441-8809
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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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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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