Provider Demographics
NPI:1104897636
Name:VASCULAR & TRANSPLANT SPECIALISTS PC
Entity type:Organization
Organization Name:VASCULAR & TRANSPLANT SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:H
Authorized Official - Last Name:GLICKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-470-5570
Mailing Address - Street 1:397 LITTLE NECK RD
Mailing Address - Street 2:3300 SOUTH BLDG STE 100
Mailing Address - City:VA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-470-5570
Mailing Address - Fax:757-227-3377
Practice Address - Street 1:397 LITTLE NECK RD
Practice Address - Street 2:3300 SOUTH BLDG STE 100
Practice Address - City:VA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-470-5570
Practice Address - Fax:757-227-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7902897OtherNC MEDICAID
VACI2484OtherRAILROAD MEDICARE
7902897OtherNC MEDICAID