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General NPI Number Information
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NPI Number | 1881589703
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Entity Type | Organization
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Legal Business Name | CENTER FOR VEIN RESTORATION MD LLC
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 1104 AMHERST ST STE 102
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City | WINCHESTER
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State | VA
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Zip | 22601-3340
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Country | US
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Telephone | 855-830-8346
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Fax |
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Provider Business Mailing Address
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Address Line | 7474 GREENWAY CENTER DR STE 1000
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City | GREENBELT
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State | MD
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Zip | 20770-3500
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Country | US
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Telephone | 240-965-3261
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | LORENA THOMAS
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Credential |
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Telephone | 815-254-1761
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) 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 | 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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