Provider Demographics
NPI:1114749439
Name:CENTER FOR VEIN RESTORATION MD LLC
Entity type:Organization
Organization Name:CENTER FOR VEIN RESTORATION MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORENA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-254-1761
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 1000
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3500
Mailing Address - Country:US
Mailing Address - Phone:815-254-1761
Mailing Address - Fax:240-473-4321
Practice Address - Street 1:8316 ARLINGTON BLVD STE 515
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:855-830-8346
Practice Address - Fax:240-473-4321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty