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General NPI Number Information
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NPI Number | 1700688348
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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 | 9707 KEY WEST AVE STE 125
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City | ROCKVILLE
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State | MD
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Zip | 20850-4004
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Country | US
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Telephone | 240-268-1224
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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 | 847-774-5300
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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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