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General NPI Number Information
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NPI Number | 1679375216
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Entity Type | Organization
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Legal Business Name | MARYLAND AND VIRGINIA PHLEBOLOGY PC
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Dates
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Enumeration Date | 03/25/2025
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Last Update Date | 03/25/2025
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Provider Practice Location Address
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Address Line | 1809 REISTERSTOWN RD STE 146
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City | PIKESVILLE
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State | MD
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Zip | 21208-6329
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Country | US
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Telephone | 410-580-0057
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Fax |
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Provider Business Mailing Address
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Address Line | 304 WAINWRIGHT DR STE 120
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City | NORTHBROOK
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State | IL
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Zip | 60062-1919
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Country | US
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Telephone | 847-257-1244
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Fax | 224-235-4652
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Authorized Official
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Title or Position | OWNER
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Name | YAN KATSNELSON
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Credential | MD
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Telephone | 847-593-8460
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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