Provider Demographics
NPI:1386935781
Name:CENTER FOR VASCULAR MEDICINE LLC
Entity type:Organization
Organization Name:CENTER FOR VASCULAR MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAKIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-982-2000
Mailing Address - Street 1:7474 GREENWAY CENTER DR STE 650
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3560
Mailing Address - Country:US
Mailing Address - Phone:301-982-2000
Mailing Address - Fax:301-982-2001
Practice Address - Street 1:7300 HANOVER PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2013
Practice Address - Country:US
Practice Address - Phone:301-441-8807
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-20
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty