# VR PHYSICIAN FOR VEIN RESTORATION

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063373009
- **Authorized official:** LORENA THOMAS (CRED MANAGER)
- **Authorized official phone:** (815) 254-1761

## Contact information

- **Practice address:** 1749 GRAND CONCOURSE, BRONX, NY 10453-8241
- **Practice address phone:** (855) 830-8346
- **Mailing address:** 7474 GREENWAY CENTER DR STE 1000, GREENBELT, MD 20770-3500
- **Mailing address phone:** (240) 965-3261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208G00000X | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/19/2025
- **Last updated:** 11/19/2025