MEDICARE: TRAVELING VEIN PHLEBOTOMY SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory

General Provider Information

NPI Number	:	1902758105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRAVELING VEIN PHLEBOTOMY SERVICES LLC

Provider Business Mailing Address
First Line	:	126 COURTLAND WOODS CIR
Second Line	:
City	:	PIKESVILLE
State	:	MD
Zip	:	21208-2600
Country	:	US
Telephone Number	:	410-831-1018
Fax Number	:

Provider Business Practice Location Address
First Line	:	750 MAIN ST STE 307
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-2517
Country	:	US
Telephone Number	:	667-305-8300
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SHANETTA MONIQUE WILLETT
Credential	:
Telephone Number	:	410-831-1018

Provider Enumeration Date	:	02/10/2026
Last Update Date	:	02/10/2026

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