Provider Demographics
NPI:1194760686
Name:VEIN INSTITUTE
Entity type:Organization
Organization Name:VEIN INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRISDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SIMONIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-573-5500
Mailing Address - Street 1:PO BOX 870
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-0870
Mailing Address - Country:US
Mailing Address - Phone:703-573-5500
Mailing Address - Fax:
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-573-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00B748V60Medicare ID - Type Unspecified
VAB73475Medicare UPIN