# GLASTONBURY VASCULAR ASSOCIATES PC

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

## Provider details

- **NPI number:** 1154972248
- **Authorized official:** LORENA ESPARZA (REVENUE CYCLE MANAGER)
- **Authorized official phone:** (630) 725-2764

## Contact information

- **Practice address:** 95 GLASTONBURY BLVD STE 202, GLASTONBURY, CT 06033-4456
- **Practice address phone:** (860) 652-8400
- **Practice address fax:** (860) 652-8401
- **Mailing address:** 2001 BUTTERFIELD RD STE 300, DOWNERS GROVE, IL 60515-1069
- **Mailing address phone:** (630) 725-2700
- **Mailing address fax:** (833) 842-5469

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | — | NULL | — |
| 202K00000X | Phlebology Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 09/20/2019
- **Last updated:** 09/20/2019